Individual
MRS. MARY A CHANEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
1334 2ND ST S, CORDOVA, IL 61242-9713
(309) 269-4631
Mailing address
1334 2ND ST S, CORDOVA, IL 61242-9713
(309) 269-4631
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
MC03040206
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MC03040206
DEVELOPMENTAL THERAPIST
IL
Enumeration date
05/22/2007
Last updated
07/08/2007
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