Individual
MORGAN STALEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6959 W 64TH ST, CHICAGO, IL 60638-4609
(708) 257-4696
Mailing address
6959 W 64TH ST, CHICAGO, IL 60638-4609
(708) 257-4696
Taxonomy
Speciality
Code
Description
License number
State
226000000X
Recreational Therapist Assistant
Primary
—
—
Other
Enumeration date
02/23/2022
Last updated
02/23/2022
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