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Individual

KELISSA JO MATEIKA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
505 COLLEGE AVE, OTTAWA, IL 61350-3858
(815) 228-3178
Mailing address
549 N 18TH RD, TONICA, IL 61370-9423
(815) 228-3178

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004478
IL

Other

Enumeration date
10/30/2018
Last updated
10/30/2018
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