Individual
MIA VACI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
16W361 S FRONTAGE RD, SUITE 131, BURR RIDGE, IL 60527-5830
(630) 590-5571
Mailing address
6116 S MASSASOIT AVE, CHICAGO, IL 60638-4516
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056011815
IL
Other
Enumeration date
01/30/2017
Last updated
01/30/2017
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