Individual
MRS. KELLEY MARIE GAITHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1874 ROBIN MILLS CT, MARYVILLE, IL 62062-5816
(618) 345-9396
(618) 343-9392
Mailing address
1874 ROBIN MILLS CT, MARYVILLE, IL 62062-5816
(618) 345-9396
(618) 343-9392
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
G36051375937
IL
Other
Enumeration date
03/16/2011
Last updated
03/16/2011
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