IndividualActive
Lisa Wade
NPI 1003576083 · Gerontology Occupational Therapist · Peoria, IL
Provider details
- NPI number
- 1003576083
- Entity type
- Individual
- Primary specialty
- Gerontology Occupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Sex
- Female
- Sole proprietor
- Yes
- License
- 057000996 (IL)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
6901 N Galena Rd
Peoria, IL 61614-3193
Phone: (309) 692-4600
Approximate (ZIP-level) locationGet directions
Mailing address
318 E Craig St
Princeville, IL 61559-9596
Registry dates
- Enumerated
- 2021-12-18
- Last updated
- 2021-12-18
- Certified
- 2021-12-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.