Individual
JARED MANLOSA BOOC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1440 N 10TH ST, QUINCY, IL 62301-1697
(217) 224-3780
Mailing address
421 N 20TH ST APT 102, QUINCY, IL 62301-2848
(217) 653-4295
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056012907
IL
Other
Enumeration date
06/17/2020
Last updated
06/17/2020
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