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1053567891
DEEPIKA MEDAVARAM
SPRINGFIELD, IL
NPI
1053567891
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
(Licence: IL 057001007)
Enumeration Date
2008-08-12
Last Update Date
2008-08-12
Business Address
DEEPIKA MEDAVARAM
3400 W WASHINGTON ST
SPRINGFIELD, IL 62711-7917
Phone number: 217-787-9600
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Mailing Address
DEEPIKA MEDAVARAM
3621 BRANDONSHIRE DR
SPRINGFIELD, IL 62704-5554
Phone number: 217-793-3185
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