Individual
GINEAL ANTWUINIQUE SMITH TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3703 W LAKE AVE STE 200, GLENVIEW, IL 60026-1266
(847) 998-1188
Mailing address
159 N MARION ST # 103, OAK PARK, IL 60301-1032
(773) 719-0557
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057001140
IL
Other
Enumeration date
05/09/2008
Last updated
05/09/2008
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