Individual
MRS. SHELLY RAE HERBOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2868 E 825TH AVE, ALTAMONT, IL 62411-3554
(618) 483-5493
Mailing address
2868 E 825TH AVE, ALTAMONT, IL 62411-3554
(618) 483-5493
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
02/13/2011
Last updated
02/13/2011
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