Individual
KAILEY N HERTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
7945 BENTONVILLE RD, DECATUR, IL 62521-9512
(217) 620-9074
Mailing address
7945 BENTONVILLE RD, DECATUR, IL 62521-9512
(217) 620-9074
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005021
IL
Other
Enumeration date
12/21/2018
Last updated
12/21/2018
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