Individual
JOSHUA ENTENMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
12171 LOVE RD, ROSCOE, IL 61073-9640
(608) 481-0400
Mailing address
12171 LOVE RD, ROSCOE, IL 61073-9640
(608) 481-0400
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003947
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057.003947
LICENSE NO.
IL
Enumeration date
12/11/2014
Last updated
04/24/2023
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