Individual
MISS ELICIA MARIE STASELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6775 PROSPERI DRIVE, TINLEY PARK, IL 60477
(708) 478-1414
Mailing address
783 STATE ROUTE 18 E, STREATOR, IL 61364
(815) 257-3713
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003888
IL
Other
Enumeration date
09/10/2013
Last updated
09/10/2013
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