Individual
JESSICA COMSTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
620 WARRINGTON AVE, DANVILLE, IL 61832-5446
(217) 649-5209
Mailing address
1573 E 750 NORTH RD, CISSNA PARK, IL 60924-8778
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003879
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NONE
—
IL
Enumeration date
12/02/2022
Last updated
12/02/2022
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