Individual
MRS. HOLLY LYNNE WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1028 W HILLCREST DR, CHILLICOTHE, IL 61523-2258
(309) 274-2194
Mailing address
14112 N RIVER CREST DR, CHILLICOTHE, IL 61523-9311
(309) 251-7194
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005036
IL
Other
Enumeration date
03/03/2020
Last updated
03/03/2020
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