Individual
MORGAN RAE LIDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
208 S MAIN ST, DIETERICH, IL 62424-1123
(217) 821-7694
Mailing address
208 S MAIN ST, DIETERICH, IL 62424-1123
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
11/24/2020
Last updated
11/24/2020
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