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Individual

COURTNEY NICOLE WOLL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
1111 UNIVERSITY DR, EDWARDSVILLE, IL 62025-5589
(618) 692-2273
Mailing address
1111 UNIVERSITY DR, EDWARDSVILLE, IL 62025-5589
(618) 692-2273

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005503
IL

Other

Enumeration date
06/15/2022
Last updated
06/15/2022
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