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Individual

AMBER DOVE EASLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1505 TRIANGLE ST, MOUNT VERNON, IL 62864-6046
(618) 316-2190
Mailing address
1505 TRIANGLE ST, MOUNT VERNON, IL 62864-6046
(618) 316-2190

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003883
IL

Other

Enumeration date
01/03/2022
Last updated
01/03/2022
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