Individual
MISS JORDAN MARIE BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
201 LOCUST ST, MINONK, IL 61760-1511
(309) 432-2557
Mailing address
530 E 6TH ST, EL PASO, IL 61738-1240
(309) 310-5513
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005630
IL
Other
Enumeration date
08/16/2021
Last updated
08/16/2021
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