Individual
EDWARD THELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7437 170TH PL, TINLEY PARK, IL 60477-4744
(708) 373-2468
(708) 620-5358
Mailing address
7437 170TH PL, TINLEY PARK, IL 60477-4744
(708) 373-2468
(708) 620-5358
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056004948
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3640571036046701
—
IL
Enumeration date
10/13/2006
Last updated
07/30/2014
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