Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | ALPP-208865 | IL |
Y | 225X00000X | Occupational Therapist | 056.010538 | IL |
NPI | 1356749576 |
---|---|
Provider Name | Ashley Welmon |
First Address | Glen Carbon, IL 62034-3517 |
Second Address | Glen Carbon, IL 62034-3517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2014 |
Last Update Date | 22/12/2014 |