Individual
PATRICIA KENERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
430 E. 162ND STREET, #246, SOUTH HOLLAND, IL 60419
(708) 466-8351
Mailing address
15105 S UNIVERSITY, DOLTON, IL 60419
(708) 829-2143
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
57000065
IL
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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