Individual
JASON ANDREW ILLIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
60 HIGHLAND RD, BETHEL PARK, PA 15102-1806
(412) 831-6050
Mailing address
4800 T REX AVE, SUITE 310, BOCA RATON, FL 33431-4479
(412) 726-7663
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP002286L
PA
Other
Enumeration date
04/05/2011
Last updated
04/05/2011
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