Individual
NIVEA LATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1510 E. 55TH, CHICAGO, IL 60615
(312) 685-2039
Mailing address
1510 E 55TH ST, CHICAGO, IL 60615-2598
(312) 685-2039
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.010873
IL
Other
Enumeration date
04/03/2020
Last updated
09/03/2021
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