Individual
MS. JENNIFER SUE WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT OTR/L
Contact information
Practice address
1101 N 11TH ST, HERRIN, IL 62948-2847
(618) 942-2436
Mailing address
1101 N 11TH ST, HERRIN, IL 62948-2847
(618) 942-2436
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
056.008757
IL
225XP0200X
Pediatric Occupational Therapist
Primary
056.008757
IL
Other
Enumeration date
08/22/2009
Last updated
05/16/2011
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