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1467749085
KELLY JEAN BAULT
CARBONDALE, IL
NPI
1467749085
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
222Q00000X Developmental Therapist
Enumeration Date
2011-07-03
Last Update Date
2011-07-03
Business Address
-- KELLY JEAN BAULT
1800 OLD WEST MAIN ST APT 204
CARBONDALE, IL 62901-2165
Phone number: 815-343-2776
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Mailing Address
-- KELLY JEAN BAULT
1800 OLD WEST MAIN ST APT 204
CARBONDALE, IL 62901-2165
Phone number: 815-343-2776
Copy
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