Individual
KEIARA BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 S BELT W, BELLEVILLE, IL 62220-2503
(618) 277-7700
Mailing address
404 HICKORY MNR, BELLEVILLE, IL 62223-3475
(618) 207-0191
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056014289
IL
Other
Enumeration date
08/03/2021
Last updated
08/03/2021
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