Most Relevant Information
Provider Data
| NPI Number: | 1003025404 |
| Provider Name: | MARY A CHANEY DT |
| Entity Type: | Individual |
| Taxonomy Code: | 222Q00000X |
| Specialty: | Developmental Therapist |
| License Number: | MC03040206 |
Most Important Dates
| Enumeration Date: | 05/22/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
1334 2ND ST S
CORDOVA
IL
612429713
Practice Location Phone/Fax
| Phone: | 3092694631 |
| Fax: |
Provider Mailing Location
1334 2ND ST S
CORDOVA
IL
612429713
Provider Mailing Phone/Fax
| Phone: | 3092694631 |
| Fax: |