Individual
KOURTNEY CHALKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
129 N SYCAMORE ST, CENTRALIA, IL 62801-3236
(618) 335-4803
Mailing address
129 N SYCAMORE ST, CENTRALIA, IL 62801-3236
(618) 335-4803
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.004644
IL
Other
Enumeration date
11/29/2016
Last updated
11/29/2016
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