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Individual

BETTY D ORR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3535 E COOK ST LOT 165, SPRINGFIELD, IL 62703-2163
(217) 721-6386
Mailing address
3535 E COOK ST LOT 165, SPRINGFIELD, IL 62703-2163
(217) 721-6386

Taxonomy

Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
O60008482815
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
884089239
STATE OF IL
IL
Enumeration date
11/17/2022
Last updated
11/17/2022
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