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General NPI Number Information
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NPI Number | 1649862947
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Entity Type | Individual
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Provider Name | CLAY DARGERT OT
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Gender | Male
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 1 VETERANS DR
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City | MANTENO
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State | IL
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Zip | 60950-9466
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Country | US
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Telephone | 815-468-6581
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Fax |
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Provider Business Mailing Address
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Address Line | 11025 W DRALLE RD
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City | MONEE
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State | IL
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Zip | 60449-9429
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Country | US
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Telephone | 815-351-4858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.014033
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License Number State | IL
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