Individual
GENE L EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
410 E 12TH ST, ALTON, IL 62002-7229
(618) 980-9151
Mailing address
410 E 12TH ST, ALTON, IL 62002-7229
(618) 980-9151
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003065
IL
Other
Enumeration date
06/25/2009
Last updated
06/25/2009
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