Individual
MIKI NESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 WHITE ST, MOUNT VERNON, IL 62864-4349
(618) 242-4075
Mailing address
6217 BAYER CIR APT 156, CARTERVILLE, IL 62918-3398
(618) 713-8916
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005243
IL
Other
Enumeration date
01/02/2021
Last updated
01/02/2021
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