Individual
DONNA YUDORA ROUNDTREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
16820 MANOR DR, SOUTH HOLLAND, IL 60473-4608
(708) 474-6590
(708) 474-6599
Mailing address
16820 MANOR DR, SOUTH HOLLAND, IL 60473-4608
(708) 474-6590
(708) 474-6599
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056002350
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635598
BLUE CROSS BLUE SHIELD
IL
Enumeration date
04/11/2007
Last updated
11/06/2008
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