Individual
MRS. MARY LORAINE RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
411 E CONGRESS PKWY, SUITE B, CRYSTAL LAKE, IL 60014-6247
(815) 459-3810
(815) 356-3550
Mailing address
411 E CONGRESS PKWY, SUITE B, CRYSTAL LAKE, IL 60014-6247
(815) 459-3810
(815) 356-3550
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.000176
IL
Other
Enumeration date
01/28/2009
Last updated
01/28/2009
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