Individual
JAMIE NICOLE BEATTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
6277 CENTER GROVE RD, EDWARDSVILLE, IL 62025-3309
(618) 659-0605
Mailing address
6277 CENTER GROVE RD, EDWARDSVILLE, IL 62025-3309
(618) 659-0605
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003292
IL
Other
Enumeration date
12/18/2020
Last updated
12/18/2020
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