Individual
MARIA ANNE PROVANCAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1804 CENTRE POINT CIR, NAPERVILLE, IL 60563-1440
(630) 955-1940
Mailing address
418 S HAWTHORNE AVE, ELMHURST, IL 60126-3715
(630) 202-3882
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
056.012310
IL
Other
Enumeration date
02/08/2018
Last updated
02/08/2018
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