Individual
TAWNYA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2232 N UNIVERSITY ST, PEORIA, IL 61604-3276
(309) 648-1213
Mailing address
2232 N UNIVERSITY ST, PEORIA, IL 61604-3276
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.001605
IL
Other
Enumeration date
09/06/2016
Last updated
09/06/2016
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