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Individual

CARLY NICOLE DECKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OT

Contact information

Practice address
929 W FOSTER AVE, CHICAGO, IL 60640-1491
(812) 236-9501
Mailing address
929 W FOSTER AVE, CHICAGO, IL 60640-1491
(812) 236-9501

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.009784
IL
225X00000X
Occupational Therapist
99049402A
IN

Other

Enumeration date
01/09/2012
Last updated
03/28/2014
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