Individual
PENNY LARAE LUZADDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
PO BOX 185, SAINTE MARIE, IL 62459-0185
(618) 455-3396
Mailing address
PO BOX 185, SAINTE MARIE, IL 62459-0185
(618) 455-3396
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056005088
IL
Other
Enumeration date
12/18/2017
Last updated
03/17/2018
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