Individual
NICOLE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
610 LOWRY ST, PITTSFIELD, IL 62363-1768
(217) 285-5200
Mailing address
505 MADISON STREET, KANE, IL 62054-0066
(217) 942-6849
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003551
IL
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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