Individual
SUE THERESE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NCBTMB
Contact information
Practice address
45 S SIDE COUNTRY CLB, DECATUR, IL 62521-9126
(217) 433-0916
Mailing address
45 S SIDE COUNTRY CLB, DECATUR, IL 62521-9126
(217) 433-0916
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.000478
IL
Other
Enumeration date
06/15/2021
Last updated
06/15/2021
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