Most Relevant Information
Provider Data
| NPI Number: | 1003576083 |
| Provider Name: | LISA BETH WADE |
| Entity Type: | Individual |
| Taxonomy Code: | 225XG0600X |
| Specialty: | Occupational Therapist |
| License Number: | 057000996 |
Most Important Dates
| Enumeration Date: | 12/18/2021 |
| Last Updated: | 12/18/2021 |
Provider Practice Location
6901 N GALENA RD
PEORIA
IL
616143193
Practice Location Phone/Fax
| Phone: | 3096924600 |
| Fax: |
Provider Mailing Location
318 E CRAIG ST
PRINCEVILLE
IL
615599596
Provider Mailing Phone/Fax
| Phone: | 3096780363 |
| Fax: |