Individual
MS. PATRICIA ANNE FENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
510 BRAMBLE ST, MANTENO, IL 60950-8303
(708) 707-9088
Mailing address
510 BRAMBLE ST, MANTENO, IL 60950-8303
(708) 707-9088
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32000088A
IN
Other
Enumeration date
06/25/2007
Last updated
07/08/2007
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