Individual
KATIE C EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
308 S 2ND ST, WALNUT, IL 61376-9364
(815) 379-2131
Mailing address
2217 N 5TH ST, CLINTON, IA 52732-2149
(563) 321-1901
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004856
IL
224Z00000X
Occupational Therapy Assistant
089435
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057004856
ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
10/05/2018
Last updated
02/26/2021
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