Individual
SAMUEL MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 W PARKER ST, PINCKNEYVILLE, IL 62274-1635
(618) 318-6871
Mailing address
101 W PARKER ST, PINCKNEYVILLE, IL 62274-1635
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003628
IL
Other
Enumeration date
06/09/2014
Last updated
06/09/2014
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