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Individual

MISS STACY M SWAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
610 LOWRY ST, PITTSFIELD, IL 62363-1768
(217) 285-5200
Mailing address
PO BOX 165, HARDIN, IL 62047-0165
(618) 576-9756

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057004981
IL

Other

Enumeration date
01/11/2019
Last updated
01/11/2019
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