Individual
MISS TRACY MARIE DANIELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1790 S FAIRVIEW AVE, DECATUR, IL 62521-4010
(217) 429-2551
(217) 422-6453
Mailing address
101 E MOULTRIE ST, BEMENT, IL 61813-1542
(217) 299-7493
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.002225
IL
Other
Enumeration date
08/20/2008
Last updated
08/20/2008
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