Individual
PHILIP MCINTOSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1915 LAKE ST, MOUNT VERNON, IL 62864-2817
(618) 315-3525
Mailing address
1915 LAKE ST, MOUNT VERNON, IL 62864-2817
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002607
IL
Other
Enumeration date
08/16/2011
Last updated
08/16/2011
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