Individual
KATY ROSE WANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 INDIGO LN, GLENVIEW, IL 60026-7797
(888) 960-8754
Mailing address
11400 197TH ST, MOKENA, IL 60448-1259
(708) 738-1802
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005261
IL
Other
Enumeration date
12/18/2021
Last updated
12/18/2021
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