Individual
VICTORIA NULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3711 N RAVENSWOOD AVE, CHICAGO, IL 60613-3599
(773) 697-7333
Mailing address
3711 N RAVENSWOOD AVE, CHICAGO, IL 60613-3599
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057-004477
IL
Other
Enumeration date
04/11/2016
Last updated
04/11/2016
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