Individual
MACY ALEXANDRA BURK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1104 OLDE LANTERN LN, BELLEVILLE, IL 62223-3267
(618) 477-4827
Mailing address
1104 OLDE LANTERN LN, BELLEVILLE, IL 62223-3267
(618) 477-4827
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005435
IL
Other
Enumeration date
05/11/2021
Last updated
05/11/2021
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