Individual
MRS. NICOLE LAVANWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1301 21ST ST, PERU, IL 61354-1359
(815) 223-4901
Mailing address
712 N 1ST ST, PRINCETON, IL 61356-1212
(815) 541-0431
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005551
IL
Other
Enumeration date
03/31/2021
Last updated
03/31/2021
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