Organization
21ST CENTURY TOTAL WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDGAR D PRATER (PRESIDENT)
(219) 756-4695
Entity
Organization
Contact information
Practice address
501 W 84TH DR STE 1, MERRILLVILLE, IN 46410-7013
(219) 756-4695
(219) 793-9629
Mailing address
501 W 84TH DR STE 1, MERRILLVILLE, IN 46410-7013
(219) 756-4695
(219) 793-9629
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32000255A
IN
Other
Enumeration date
02/05/2007
Last updated
08/22/2020
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