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Individual

JACK MA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
4020 E NEW YORK ST, AURORA, IL 60504-4416
(331) 301-5590
Mailing address
811 MORAN ST, JOLIET, IL 60435-4534

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005543
IL

Other

Enumeration date
04/07/2023
Last updated
11/04/2025
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