Individual
MISS MARISA OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1510 REEVESVILLE RD, GRANTSBURG, IL 62943-2016
(618) 771-2144
Mailing address
1510 REEVESVILLE RD, GRANTSBURG, IL 62943-2016
(618) 771-2144
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.008838
IL
Other
Enumeration date
10/20/2021
Last updated
10/20/2021
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