Individual
MARY L. WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
211 W LAWRENCE AVE, EFFINGHAM, IL 62401-2630
(217) 347-1037
Mailing address
211 W LAWRENCE AVE, EFFINGHAM, IL 62401-2630
(217) 347-1037
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
11/17/2010
Last updated
11/17/2010
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