Individual
MISS HOLLY SUZANNE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSOTR/L
Contact information
Practice address
202 WEST DAVENPORT STREET, CROSSVILLE, IL 62827
(618) 928-4801
Mailing address
202 WEST DAVENPORT STREET, CROSSVILLE, IL 62827
(618) 928-4801
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
056.008560
IL
314000000X
Skilled Nursing Facility
31004566A
IN
Other
Enumeration date
09/10/2010
Last updated
09/10/2010
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