Individual
MRS. KELLY JEAN MANSOURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3703 W LAKE AVE, SUITE 200, GLENVIEW, IL 60026-5823
(847) 998-1188
Mailing address
811 REEF CT, WHEELING, IL 60090-7300
(847) 459-9755
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.000587
IL
Other
Enumeration date
04/23/2008
Last updated
09/06/2023
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