Individual
DEMI MOSES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3049 W HARRISON ST, CHICAGO, IL 60612-3342
(773) 533-9605
Mailing address
3049 W HARRISON ST, CHICAGO, IL 60612-3342
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
225X00000X
Occupational Therapist
Primary
056013709
IL
Other
Enumeration date
05/18/2020
Last updated
10/08/2020
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