Individual
JESSICA ALYSE GRUNDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
875 W MCKINLEY AVE, DECATUR, IL 62526-3287
(217) 872-1282
Mailing address
2474 N FLORIAN AVE APT 2, DECATUR, IL 62526-3083
(217) 520-9099
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.012037
IL
Other
Enumeration date
02/07/2019
Last updated
02/07/2019
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