Individual
DANA LYNN WHITLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2120 W WASHINGTON ST, SPRINGFIELD, IL 62702-4630
(217) 793-4880
Mailing address
1746 W HOMEWOOD AVE, SPRINGFIELD, IL 62704-4854
(217) 341-8110
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003055
IL
Other
Enumeration date
10/30/2017
Last updated
10/30/2017
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