Individual
MARTINA GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3611 N ROCHELLE LN, PEORIA, IL 61604-1038
(309) 686-4169
Mailing address
3611 N ROCHELLE LN, PEORIA, IL 61604-1038
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056000665
IL
Other
Enumeration date
06/16/2010
Last updated
06/16/2010
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