Individual
KEELY REECE THEOBALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
2086 7TH STREET, CHARLESTON, IL 61920
(217) 581-2712
Mailing address
2086 7TH STREET, CHARLESTON, IL 61920
(217) 581-2712
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
IL
Other
Enumeration date
06/12/2020
Last updated
06/12/2020
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