Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056.011260 | IL |
NPI | 1053783142 |
---|---|
Provider Name | Alexander James Porter |
First Address | North Aurora, IL 60542-5143 |
Second Address | North Aurora, IL 60542-5143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2015 |
Last Update Date | 28/10/2015 |