Individual
BRENTON RAINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
13138 IL-13, COULTERVILLE, IL 62237
(618) 758-2256
Mailing address
1512 HYLAND RD APT 5, CHESTER, IL 62233-1245
(618) 615-8241
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005153
IL
Other
Enumeration date
06/13/2019
Last updated
06/13/2019
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