Individual
MRS. STACEY LYNN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
18 PINEWOOD RD, LITCHFIELD, IL 62056-1706
(217) 556-9126
Mailing address
18 PINEWOOD RD, LITCHFIELD, IL 62056-1706
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003532
IL
Other
Enumeration date
04/06/2020
Last updated
04/06/2020
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