Individual
MS. COURTNEY DYAN KIRK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4815 N MARTIN LUTHER KING JR DR, APT 112, DECATUR, IL 62526-6127
(217) 412-1422
Mailing address
4815 N MARTIN LUTHER KING JR. DR., APT 112, DECATUR, IL 62526
(217) 412-1422
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
11/20/2009
Last updated
11/20/2009
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