Individual
MR. RANDALL THOMAS WESLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
820 S DAMEN AVE, CHICAGO, IL 60612-3728
(312) 569-8387
Mailing address
10409 S TROY ST, CHICAGO, IL 60655-2023
(773) 807-2015
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
APPLIED FOR
IL
Other
Enumeration date
06/03/2011
Last updated
06/03/2011
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