Individual
LEAH DERLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 MICHAEL AVE, ZION, IL 60099-9224
(224) 353-9424
Mailing address
2400 MICHAEL AVE, ZION, IL 60099-9224
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.002881
IL
224Z00000X
Occupational Therapy Assistant
1752-027
WI
Other
Enumeration date
02/22/2009
Last updated
06/22/2010
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