Individual
EMILY CAROLINE MACIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1373 DADRIAN PROFESSIONAL PARK, GODFREY, IL 62035-1767
(618) 467-7062
Mailing address
4622 VALLEYDALE RD, GODFREY, IL 62035-4715
(618) 600-3391
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005398
IL
Other
Enumeration date
07/09/2020
Last updated
07/09/2020
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