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Individual

MARY BIRCHENOUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1405 N 2ND ST, SWANSEA, IL 62226-4213
(618) 233-6625
Mailing address
1200 ANISE CT, FREEBURG, IL 62243-2118

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056010308
IL

Other

Enumeration date
12/18/2019
Last updated
12/18/2019
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