Individual
MRS. KELLI RAE DESPLINTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
16142 E 2600 ST, ANNAWAN, IL 61234
(309) 540-9278
Mailing address
16142 E 2600TH ST, ANNAWAN, IL 61234-9533
(309) 540-9278
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.004749
IL
Other
Enumeration date
03/16/2010
Last updated
03/16/2010
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