Individual
ELLEN MARIE WARNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
601 W LINCOLN AVE, CASEYVILLE, IL 62232-1306
(618) 344-9355
(618) 344-9356
Mailing address
1217 WOODBRIDGE ST, COLLINSVILLE, IL 62234-3882
(618) 580-8976
(618) 345-5904
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057001621
IL
Other
Enumeration date
07/16/2012
Last updated
07/16/2012
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