Individual
MRS. STACY BLIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
932 LOUISE DR, MOMENCE, IL 60954
(708) 400-1173
Mailing address
932 LOUISE DR, MOMENCE, IL 60954-2326
(708) 400-1173
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002262
IL
Other
Enumeration date
03/24/2016
Last updated
03/24/2016
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