Individual
MRS. CLARA NANETTE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
801 E REEVES ST, MARION, IL 62959-3366
(618) 534-2432
(618) 993-1615
Mailing address
2763 BOSKYDELL RD, CARBONDALE, IL 62902-7714
(618) 457-7832
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.003044
IL
Other
Enumeration date
10/20/2012
Last updated
10/20/2012
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