Aspen Quadri

Individual provider Active NPI Occupational Therapy Assistant · Walnut, IL

NPI 1275005654 · NPPES record last updated Dec 21, 2018

Key facts

NPI
1275005654
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
057.005086 (IL)
Practice address
308 S 2ND St
Walnut, IL 61376-9364
Phone
(815) 379-2131
NPI assigned
Dec 21, 2018
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
057.005086ILMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 057.005086 IL Yes

Addresses

Primary practice location

308 S 2ND St
Walnut, IL 61376-9364

Mailing address

1110 E 37TH St Apt 213
Davenport, IA 52807-1757

Other providers in Walnut, IL

All providers in Walnut, IL · Occupational Therapy Assistant in Illinois

Sources for this page

Verify at the official NPI Registry.