Individual
MS. KELLIE MARIE HEADRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
924 S COMMERCIAL ST, HARRISBURG, IL 62946-2637
(618) 252-7171
(618) 252-7272
Mailing address
401 W WALNUT ST, CARRIER MILLS, IL 62917-1181
(618) 599-5621
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004130
IL
224Z00000X
Occupational Therapy Assistant
BOTOTA00210165
KY
Other
Enumeration date
01/05/2015
Last updated
01/05/2015
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