Individual
SANDRA M MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
400 W WASHINGTON AVE, CHRISMAN, IL 61924-1042
(217) 269-2105
(217) 269-2108
Mailing address
400 W WASHINGTON AVE, CHRISMAN, IL 61924-1042
(217) 269-2105
(217) 269-2108
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002718
IL
Other
Enumeration date
08/26/2010
Last updated
08/26/2010
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