Individual
DANIEL STEVEN BREEDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
601 LUTZ RD, BLOOMINGTON, IL 61704-8608
(309) 557-8000
Mailing address
203 N WEST ST, GIFFORD, IL 61847-9520
(309) 251-0403
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005478
IL
Other
Enumeration date
03/22/2021
Last updated
03/22/2021
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