Individual
BRANDI HICKAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1329 IL-3 SUITE 4, WATERLOO, IL 62298
(618) 939-7761
Mailing address
1329 IL-3 SUITE 4, WATERLOO, IL 62298
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005879
IL
Other
Enumeration date
06/11/2024
Last updated
06/11/2024
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