Individual
SAMUEL OSEI BOATENG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5100 S DORCHESTER AVE, CHICAGO, IL 60615-4118
(773) 966-5039
Mailing address
3530 S LAKE PARK AVE APT 102, CHICAGO, IL 60653-1420
(773) 526-9096
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
344408315
—
IL
Enumeration date
05/27/2022
Last updated
05/27/2022
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