Individual
MRS. JENNIFER MARIE RIEDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
412 1750TH AVE, MOUNT PULASKI, IL 62548-6641
(217) 871-5302
Mailing address
412 1750TH AVE, MT. PULASKI, IL 62548
(217) 871-5302
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.002570
IL
Other
Enumeration date
07/16/2014
Last updated
07/16/2014
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