Individual
BARBARA THAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT/L
Contact information
Practice address
2040 TIMBERBROOK DR, SPRINGFIELD, IL 62702-6623
(217) 726-1946
Mailing address
19 LAKE RIDGE CT, BLOOMINGTON, IL 61701-1475
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056000212
IL
Other
Enumeration date
07/09/2008
Last updated
07/09/2008
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