Individual
JODY CAROL CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1000 N ALLEN ST, ROBINSON, IL 62454-1114
(618) 546-2695
Mailing address
2610 SPRINGFIELD AVE, LAWRENCEVILLE, IL 62439-1850
(812) 887-8022
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002015
IL
Other
Enumeration date
04/17/2019
Last updated
04/17/2019
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