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Individual

MADISON SHAY LAZENBY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
820 E TERRA COTTA AVE STE 244, CRYSTAL LAKE, IL 60014-3655
(815) 354-8200
Mailing address
34 PINE CIR, CARY, IL 60013-1572
(708) 571-5404

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.006216
IL

Other

Enumeration date
04/11/2025
Last updated
04/11/2025
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