Individual
MRS. KATHLEEN FINLEY LICAVOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
1118 HAMPSHIRE ST, QUINCY, IL 62301-3027
(217) 222-6550
Mailing address
1025 MAINE ST, QUINCY, IL 62301-4038
(217) 222-6550
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056008866
IL
225X00000X
Occupational Therapist
2006026900
MO
Other
Enumeration date
03/08/2007
Last updated
05/07/2013
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