Individual
STEPHANIE LEE MABUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
873 GORVE ST, JACKSONVILLE, IL 62650
(217) 479-3400
Mailing address
15248 COUNTRY LAKE ESTATES RD, GIRARD, IL 62640-7285
(618) 292-3035
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003071
IL
Other
Enumeration date
12/31/2019
Last updated
12/31/2019
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