Individual
SANTINA BRANCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
23525 W MILTON RD, WAUCONDA, IL 60084-2619
(847) 438-5400
Mailing address
4606 189TH ST, COUNTRY CLUB HILLS, IL 60478-5419
(708) 945-5909
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005165
IL
Other
Enumeration date
04/28/2019
Last updated
04/28/2019
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