Individual
LISA LABOTTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
900 W WHITE ST, MARION, IL 62959-1855
(618) 889-3220
(618) 969-7174
Mailing address
900 W WHITE ST, MARION, IL 62959-1855
(618) 889-3220
(618) 969-7174
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.006986
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227.006986
ILLINOIS DEPARTMENT OF FEDERAL AND PROFESSIONAL REGULATION
IL
Enumeration date
01/06/2015
Last updated
01/06/2015
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