Individual
SUSANA JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2649 E. 75TH ST, CHICAGO, IL 60649
(773) 356-9300
Mailing address
2649 E 75TH ST, CHICAGO, IL 60649-3835
(773) 356-9300
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004397
IL
Other
Enumeration date
11/22/2016
Last updated
11/22/2016
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