Individual
MR. IAN S STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2170 W NAVAJO DR, FREEPORT, IL 61032-0010
(815) 233-2400
(815) 233-9272
Mailing address
1918 HAWKS RIDGE DR, APT 201, VERONA, WI 53593-8511
(815) 233-2400
(815) 233-9272
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.010403
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056.010403
STATE LICENSE
IL
Enumeration date
07/10/2014
Last updated
07/10/2014
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