Individual
MS. BREANNA KAITLYN CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
168 BEACONRIDGE DR, BOLINGBROOK, IL 60440-2936
(815) 260-2977
Mailing address
168 BEACONRIDGE, BOLINGBROOK, IL 60440
(815) 260-2977
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
04/17/2013
Last updated
04/17/2013
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