Individual
MS. TADESA ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1006 N BROOKFIELD ST, SOUTH BEND, IN 46628-2604
(574) 300-5645
Mailing address
53027 JUDAY CREEK BLVD, GRANGER, IN 46530-9463
(574) 300-5645
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003476
IL
Other
Enumeration date
01/24/2012
Last updated
11/06/2019
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