Individual
MRS. ANDRIA LYNN BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
310 N 1ST ST, ROCKFORD, IL 61107-3902
(815) 904-2051
Mailing address
310 N 1ST ST, ROCKFORD, IL 61107-3902
(815) 904-2051
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.002044
IL
Other
Enumeration date
06/25/2009
Last updated
06/25/2009
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