Individual
BAYLEE ASHTYNN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 W SAINT LOUIS AVE, VANDALIA, IL 62471-2535
(618) 283-4262
Mailing address
2215 BRIAN ST, VANDALIA, IL 62471-4103
(618) 704-5026
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005141
IL
Other
Enumeration date
02/02/2022
Last updated
02/02/2022
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