Individual
REBECCA L GOLLADAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR-L
Contact information
Practice address
212 EDWARDS DR, NORMAL, IL 61761-2334
(309) 824-7417
Mailing address
212 EDWARDS DR, NORMAL, IL 61761-2334
(309) 824-7417
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
056006902
IL
225XP0200X
Pediatric Occupational Therapist
5657
NC
Other
Enumeration date
06/22/2007
Last updated
02/14/2017
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