Most Relevant Information
Provider Data
| NPI Number: | 1003525940 |
| Provider Name: | ELIZABETH DIVINE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/18/2022 |
| Last Updated: | 11/18/2022 |
Provider Practice Location
634 N MAIN ST
O FALLON
IL
622693751
Practice Location Phone/Fax
| Phone: | 6187265870 |
| Fax: |
Provider Mailing Location
634 N MAIN ST
O FALLON
IL
622693751
Provider Mailing Phone/Fax
| Phone: | 6187265870 |
| Fax: |