Individual
MS. LISA MARIE MANGELSDORFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
14520 HAMLIN AVE, MIDLOTHIAN, IL 60445-2816
(708) 925-9922
Mailing address
14520 HAMLIN AVE, MIDLOTHIAN, IL 60445-2816
(708) 925-9922
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057-001348
IL
Other
Enumeration date
02/26/2009
Last updated
02/26/2009
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