Individual
HAYLEY ELIZABETH MANTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3703 W LAKE AVE, SUITE 200, GLENVIEW, IL 60026-1223
(847) 998-1188
Mailing address
215 E 37TH AVE APT 1, GRIFFITH, IN 46319-1157
(219) 513-9629
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003320
IL
Other
Enumeration date
12/07/2010
Last updated
12/07/2010
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