Individual
TRISHA WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
513 S CHESTNUT ST, PANA, IL 62557-1505
(217) 433-2704
Mailing address
513 S CHESTNUT ST, PANA, IL 62557-1505
(217) 433-2704
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/09/2014
Last updated
10/09/2014
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