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Individual

BETSY OLIVIA MILLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2035 W ILES AVE, SUITE C, SPRINGFIELD, IL 62704-4192
(217) 679-5080
(217) 679-5386
Mailing address
PO BOX 195, PAWNEE, IL 62558-0195
(217) 254-5542

Taxonomy

Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
M460-0749-0640
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
M460-0749-0640
DRIVERS LICENSE
IL
Enumeration date
12/18/2013
Last updated
12/18/2013
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