Individual
MS. DOREEN VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
4815 S WESTERN BLVD, CHICAGO, IL 60609-4067
(773) 927-4200
Mailing address
4815 S WESTERN BLVD, CHICAGO, IL 60609-4067
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057001132
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057001132
STATE OF ILLINOIS
IL
Enumeration date
04/30/2008
Last updated
04/30/2008
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