Individual
CYNTHIA OTOOLE - GRANBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3615 W GATE PKWY, ROCKFORD, IL 61108-6162
(815) 229-2881
Mailing address
3615 W GATE PKWY, ROCKFORD, IL 61108-6162
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235Z00000X
—
IL
Enumeration date
12/28/2017
Last updated
12/28/2017
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