JONATHAN ETHAN WHITE

SOUTH HOLLAND, IL
NPI1225374366
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy224Z00000X Occupational Therapy Assistant
(Licence: IL  057003706)
Enumeration Date2012-12-18
Last Update Date2012-12-18
Business Address
-- JONATHAN ETHAN WHITE cota
751 E 163RD PL
SOUTH HOLLAND, IL 60473-2306
Phone number: 708-439-0654
Mailing Address
-- JONATHAN ETHAN WHITE cota
751 EAST 163RD PLACE
SOUTH HOLLAND, IL 60473
Phone number: 708-439-0654
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