Individual
EVAN BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
5277 E MARYLAND ST, DECATUR, IL 62521-9705
(217) 408-5091
Mailing address
5277 E MARYLAND ST, DECATUR, IL 62521-9705
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
06/07/2025
Last updated
06/07/2025
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