Individual
KATELYN ELIZABETH VALLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1373 DADRIAN PROFESSIONAL PARK, GODFREY, IL 62035-1767
(618) 467-7062
Mailing address
429 CORRAL DR, HAMEL, IL 62046-1045
(618) 972-6948
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003368
IL
Other
Enumeration date
07/05/2018
Last updated
07/05/2018
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