Individual
LAQUITA HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19000 HALSTED ST, HOMEWOOD, IL 60430-4204
(708) 957-9200
Mailing address
120 156TH ST, CALUMET CITY, IL 60409-4628
(708) 639-1636
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005087
IL
Other
Enumeration date
07/03/2019
Last updated
07/03/2019
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