Individual
AUDRA CHRISTAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8020 126TH ST W, ANDALUSIA, IL 61232-9235
(702) 682-8372
Mailing address
8020 126TH ST W, ANDALUSIA, IL 61232-9235
(702) 682-8372
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
12312015
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123112015
LISENCE NUMBER OT
IL
Enumeration date
01/17/2014
Last updated
01/17/2014
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