Individual
JANA L MULLINAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/ L
Contact information
Practice address
299 SWAN AVE, CENTRALIA, IL 62801-6127
(618) 533-4423
Mailing address
PO BOX 1946, CENTRALIA, IL 62801-9127
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.001371
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057.001371
CERTIFIED OCCUPATIONAL THERAPY ASSISTANT
IL
Enumeration date
05/20/2011
Last updated
05/20/2011
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