Individual
MADENA WHITESELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
201 LOCUST ST, MINONK, IL 61760-1511
(309) 432-2557
(309) 432-3330
Mailing address
550 FRONTAGE RD, SUITE 2415, NORTHFIELD, IL 60093-1202
(847) 441-5593
(847) 441-0734
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057001032
IL
Other
Enumeration date
06/16/2010
Last updated
06/16/2010
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