Individual
MALISSA ROSE BLUM II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
154 OAK BLUFF TER, UTICA, IL 61373-9509
(815) 830-3994
Mailing address
154 OAK BLUFF TER, UTICA, IL 61373-9509
(815) 830-3994
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
05/04/2021
Last updated
05/04/2021
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