Individual
ALLISON JUNE WINGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1503 DUBLIN DR, NORMAL, IL 61761-5430
(309) 846-8281
Mailing address
1503 DUBLIN DR, NORMAL, IL 61761-5430
(309) 846-8281
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.004771
IL
Other
Enumeration date
08/22/2017
Last updated
08/22/2017
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