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Individual

ASHLEY TAVENNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1601 BUTTERFIELD TRL, KANKAKEE, IL 60901-2959
(815) 936-6500
Mailing address
PO BOX 111, LUDLOW, IL 60949-0111
(217) 418-0105

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary

Other

Enumeration date
06/21/2022
Last updated
06/21/2022
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