Individual
HAZEL FUERTES-DIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
225 EINHAUS LN, QUINCY, IL 62305-1001
(217) 220-9245
Mailing address
225 EINHAUS LN, QUINCY, IL 62305-1001
(217) 220-9245
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056008638
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056008638
ILLINOIS BOARD OF OCCUPATIONAL THERAPY
IL
Enumeration date
12/19/2016
Last updated
12/19/2016
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