Individual
MALORIE DEFORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1205 INDIANA AVE, MENDOTA, IL 61342-1650
(815) 414-1136
Mailing address
1205 INDIANA AVE, MENDOTA, IL 61342-1650
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056014108
IL
Other
Enumeration date
03/03/2021
Last updated
03/03/2021
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