Individual
MRS. MARY JAMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L, LMT
Contact information
Practice address
6778 MILL RD STE 300, ROCKFORD, IL 61108-2502
(815) 739-0793
Mailing address
737 W IL ROUTE 64, OREGON, IL 61061-9352
(815) 739-0793
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227021164
IL
Other
Enumeration date
11/19/2020
Last updated
11/19/2020
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