Individual
CANDACE MALLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
349 PINOAK DR, BARTLETT, IL 60103-4439
(630) 213-0141
Mailing address
349 PINOAK DR, BARTLETT, IL 60103-4439
(630) 213-0141
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057000163
IL
Other
Enumeration date
06/04/2012
Last updated
06/04/2012
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