Individual
KYLIE WIELGOPOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT, CHT
Contact information
Practice address
4996 ILLINOIS ROUTE 159, SUITE B, MARYVILLE, IL 62062
(618) 288-4677
Mailing address
2491 INDUSTRIAL CT STE 100, HIGHLAND, IL 62249-1365
(815) 488-8040
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
056010241
IL
Other
Enumeration date
05/01/2024
Last updated
05/01/2024
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