Individual
NICOLLE D RETZLAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2810 FRANK SCOTT PKWY W, SUITE 824, BELLEVILLE, IL 62223-5007
(618) 234-9705
(618) 257-0665
Mailing address
2810 FRANK SCOTT PKWY W, SUITE 824, BELLEVILLE, IL 62223-5007
(618) 234-9705
(618) 257-0665
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056009458
IL
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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