Individual
LATANJA MANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
291 PROVIDENCE DR, MATTESON, IL 60443-1292
(708) 720-5193
Mailing address
291 PROVIDENCE DR, MATTESON, IL 60443-1292
(708) 720-5193
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056004729
IL
Other
Enumeration date
06/29/2008
Last updated
06/29/2008
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