Individual
MRS. REBBECCA ANN GWALTNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2352 STATE HIGHWAY 78 N, JACKSONVILLE, IL 62650-6227
(217) 473-5913
Mailing address
2352 STATE HIGHWAY 78 N, JACKSONVILLE, IL 62650-6227
(217) 473-5913
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
057.002498
IL
Other
Enumeration date
05/24/2012
Last updated
05/24/2012
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