Individual
SHELBY FAYEANN DURBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5534 N KENMORE AVE APT 202, CHICAGO, IL 60640-1542
(217) 823-9164
Mailing address
5534 N KENMORE AVE APT 202, CHICAGO, IL 60640-1542
(217) 823-9164
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005133
IL
Other
Enumeration date
05/20/2019
Last updated
05/20/2019
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