Individual
MS. NAKITA PORK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
158 FREDERICK DR, CHICAGO HEIGHTS, IL 60411-1031
(708) 207-3352
Mailing address
158 FREDERICK DR, CHICAGO HEIGHTS, IL 60411-1031
(708) 207-3352
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056005106
IL
Other
Enumeration date
06/18/2013
Last updated
06/18/2013
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