Individual
JOSE CARLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2612 W LELAND AVE, APT # 2, CHICAGO, IL 60625-2986
(312) 339-0653
Mailing address
2612 W LELAND AVE, APT # 2, CHICAGO, IL 60625-2986
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.002854
IL
Other
Enumeration date
10/14/2010
Last updated
10/14/2010
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