Individual
DOMINIQUE DEVON NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13259 S CENTRAL AVE, CRESTWOOD, IL 60418-2901
(708) 597-1000
Mailing address
3728 215TH ST, MATTESON, IL 60443-2754
(708) 774-7041
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005651
IL
Other
Enumeration date
10/02/2021
Last updated
10/02/2021
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