Individual
MRS. ELLEN MARIE TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
4823 STOREYLAND DR, ALTON, IL 62002-5835
(312) 593-4871
Mailing address
4823 STOREYLAND DR, ALTON, IL 62002-5835
(312) 593-4871
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.007674
IL
Other
Enumeration date
04/16/2007
Last updated
10/27/2014
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