Individual
JENNA NOELLE MUSGRAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
550 W FRONTAGE RD STE 2415, NORTHFIELD, IL 60093-1212
(877) 787-3430
Mailing address
1026 PINECREST DR, RANTOUL, IL 61866-1213
(217) 417-1456
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002974
IL
Other
Enumeration date
10/02/2014
Last updated
10/02/2014
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