Individual
ANNA BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
97 EASTGATE DR, WASHINGTON, IL 61571-9271
(800) 773-1682
Mailing address
128 WASHINGTON SQ, WASHINGTON, IL 61571-2657
(800) 773-1682
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004089
IL
Other
Enumeration date
08/07/2014
Last updated
08/07/2014
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