Individual
KELLY SUPATARAPORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
388 TWIN CREEKS DR, BOLINGBROOK, IL 60440-1070
(630) 453-0134
Mailing address
388 TWIN CREEKS DR, BOLINGBROOK, IL 60440-1070
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.009273
IL
Other
Enumeration date
12/06/2011
Last updated
12/06/2011
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