Individual
CANDACE LEE MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
611 S MARSHALL AVE, MC LEANSBORO, IL 62859-1213
(618) 643-2361
(618) 643-3657
Mailing address
611 S MARSHALL AVE, MC LEANSBORO, IL 62859-1213
(618) 643-2361
(618) 643-3657
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003021
IL
Other
Enumeration date
02/15/2013
Last updated
02/15/2013
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