Individual
MRS. ANDREA DIONNE ILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
11120 ROCK RIDGE RD, OKLAHOMA CITY, OK 73120-5721
(405) 752-1272
Mailing address
11120 ROCK RIDGE RD, OKLAHOMA CITY, OK 73120-5721
(405) 752-1272
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1513
OK
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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