Individual
JESSICA SAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
404 BROADWAY ST, GILLESPIE, IL 62033-1105
(217) 324-2153
(217) 324-2770
Mailing address
628 S ILLINOIS AVE, LITCHFIELD, IL 62056-2716
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
0057002560
IL
224Z00000X
Occupational Therapy Assistant
Primary
057002560
IL
Other
Enumeration date
08/06/2014
Last updated
08/06/2014
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