Individual
MICHELLE PITSTICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
111 SPRING ST, STREATOR, IL 61364-3332
(815) 673-2311
Mailing address
111 SPRING ST, STREATOR, IL 61364-3332
(815) 673-4566
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056008614
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056008614
LICENSE
IL
Enumeration date
11/25/2009
Last updated
07/03/2012
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