Individual
LISA ANN SCANZONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
708 N DENEEN ST, STAUNTON, IL 62088-1016
(618) 410-0218
Mailing address
708 N DENEEN ST, STAUNTON, IL 62088-1016
(618) 410-0218
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003773
IL
224Z00000X
Occupational Therapy Assistant
2013006908
MO
Other
Enumeration date
04/10/2013
Last updated
04/10/2013
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