Individual
KATHLEEN WYNNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 BIRNIE AVE STE 304, SPRINGFIELD, MA 01107-1121
(413) 781-1054
(413) 930-3360
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/11/2018
Last updated
10/04/2024
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