Individual
CARISSA GUALANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-19-79860
IL
225XP0200X
Pediatric Occupational Therapist
Primary
056.015084
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-749860
RBT
IL
Enumeration date
09/05/2019
Last updated
05/04/2023
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