Individual
LATANYA RENE SPILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MMP, LMT
Contact information
Practice address
2422 E WASHINGTON ST, #105, BLOOMINGTON, IL 61704
(309) 662-3905
Mailing address
211 SARATOGA RD, NORMAL, IL 61761
(404) 551-9155
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
277017151
IL
Other
Enumeration date
03/12/2021
Last updated
03/12/2021
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