Individual
MR. ANTHONY PONCE LUMANGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
3703 W LAKE AVE, SUITE 200, GLENVIEW, IL 60026-5823
(847) 998-1188
Mailing address
6954 N WOLCOTT AVE UNIT 3, CHICAGO, IL 60626-3126
(847) 848-5708
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.002148
IL
Other
Enumeration date
04/30/2008
Last updated
04/30/2008
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