Amanda Dianne Gough MS, ATC

NPI 1710213178 - Specialist/Technologist - 2255A2300X

NPI Details
NPI 1710213178
Gender Female
Enumeration Date 10/20/2009
Last Updated 10/20/2009
Entity Type Individual
Active Over 7 years ago
Practice Location
25 W LINCOLN AVE
CHARLESTON IL, 61920-3070, US
Phone (217) 345-9600
Fax
Business Location
125 W JACKSON AVE
CHARLESTON IL, 61920-1814, US
Phone (618) 562-2449
Fax
Toxanomy
Taxonomy Code 2255A2300X
License State Illinois
License Number 096.002672
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According to our database, Mrs. Amanda Dianne Gough MS, ATC NPI is 1710213178, taxonomy code is 2255A2300X and license number is 096.002672, license state is located at Illinois. Amanda Dianne Gough MS, ATC physically located at 25 W Lincoln Ave, Charleston IL, 61920-3070. NPI Number Amanda Dianne Gough MS, ATC has the Individual type.

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1710213178 NPI number is provided on an as is basis without warranty of any kind. 1710213178 is maintained by the National Plan & Provider Enumeration System. The contents of Amanda Dianne Gough MS, ATC are for informational purposes only.