Individual
ALLIE MCKENZIE MELVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1700 WHITE ST, MOUNT VERNON, IL 62864-4349
(618) 242-4075
(618) 242-4092
Mailing address
533 S MADISON ST, DU QUOIN, IL 62832-2432
(618) 242-4075
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005858
IL
Other
Enumeration date
08/25/2022
Last updated
08/25/2022
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