Individual
MRS. LISA DAWN KUBOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
216 COLLEGE BLVD, CARMI, IL 62821-1548
(618) 382-5125
Mailing address
216 COLLEGE BLVD, CARMI, IL 62821-1548
(618) 382-5125
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003117
IL
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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