Individual
LESLIE PALOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1304 LOCKE ST, JERSEYVILLE, IL 62052-2660
(618) 535-6628
Mailing address
1304 LOCKE ST, JERSEYVILLE, IL 62052-2660
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002678
IL
Other
Enumeration date
08/15/2014
Last updated
08/15/2014
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