Individual
MRS. MARY THERESA WIRTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.R.
Contact information
Practice address
40640 N GRAND AVE, ANTIOCH, IL 60002-8736
(847) 395-9270
(847) 395-9272
Mailing address
40640 N GRAND AVE, ANTIOCH, IL 60002-8736
(847) 395-9270
(847) 395-9272
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
IL
Other
Enumeration date
08/01/2006
Last updated
07/08/2007
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