Individual
MISS STEPHANIE LYNN WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3400 W WASHINGTON ST, SPRINGFIELD, IL 62711-7917
(217) 787-9600
Mailing address
604 W LINCOLN AVE, PETERSBURG, IL 62675-1666
(217) 632-0236
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002403
IL
Other
Enumeration date
07/28/2008
Last updated
07/28/2008
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