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General NPI Number Information
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NPI Number | 1003025404
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Entity Type | Individual
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Provider Name | MARY A CHANEY DT
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1334 2ND ST S
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City | CORDOVA
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State | IL
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Zip | 61242-9713
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Country | US
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Telephone | 309-269-4631
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Fax |
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Provider Business Mailing Address
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Address Line | 1334 2ND ST S
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City | CORDOVA
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State | IL
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Zip | 61242-9713
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Country | US
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Telephone | 309-269-4631
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | MC03040206
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License Number State | IL
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