Individual
AMANDA JO PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
5 DOCTORS PARK RD, MOUNT VERNON, IL 62864-6224
(618) 242-1064
Mailing address
215 E 7TH ST, CENTRALIA, IL 62801-4503
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056012079
IL
Other
Enumeration date
01/16/2018
Last updated
01/16/2018
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