Individual
MRS. HOLLY RENEE SHOESMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
13829 VINCENNES DR, CARLYLE, IL 62231-2539
(618) 594-8067
Mailing address
13829 VINCENNES DR, CARLYLE, IL 62231-2539
(618) 594-8067
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
160.005504
IL
Other
Enumeration date
02/14/2014
Last updated
02/14/2014
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