Individual
AMANDA BAUCOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
604 OAKWOOD DR, STRONGHURST, IL 61480-5052
(309) 924-1123
Mailing address
3329 235TH ST, DE WITT, IA 52742-9205
(432) 661-2262
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056011582
IL
Other
Enumeration date
08/29/2018
Last updated
08/29/2018
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