Individual
NICOLE SUE DETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
503 N MAPLE ST, EFFINGHAM, IL 62401-2006
(217) 347-1243
(217) 347-1558
Mailing address
503 N MAPLE ST, EFFINGHAM, IL 62401-2006
(217) 347-1243
(217) 347-1558
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056009838
IL
Other
Enumeration date
10/12/2012
Last updated
10/12/2012
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