Individual
JACEK TOMASZ TOMCZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3718 W CORNELIA AVE, CHICAGO, IL 60618-5002
(773) 791-1157
Mailing address
3718 W CORNELIA AVE, CHICAGO, IL 60618-5002
(773) 791-1157
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056013264
IL
Other
Enumeration date
12/04/2019
Last updated
12/04/2019
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