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Individual

PETER WAMBUGU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1251 N STATE ST, JERSEYVILLE, IL 62052-1169
(618) 498-6441
Mailing address
2812 ROYALLVALLEY WAY, O FALLON, MO 63368-6989
(314) 441-0103

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.003928
IL

Other

Enumeration date
09/23/2020
Last updated
09/23/2020
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