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Individual

MAXINE DIANNA WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
10300 SOUTH WEST HIGHWAY LEXINGTON, CHICAGO RIDGE, IL 60615
(708) 945-3455
Mailing address
14508 S WESTERN AVE, POSEN, IL 60469-1331
(708) 945-3455

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002692
IL

Other

Enumeration date
09/16/2010
Last updated
09/16/2010
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