Individual
MARY ALICE KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
805 E. SPRUCE, CHATHAM, IL 62692
(217) 483-4643
Mailing address
805 E. SPRUCE, CHATHAM, IL 62692
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056000571
IL
Other
Enumeration date
09/11/2012
Last updated
09/11/2012
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