Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056004678 | IL |
N | 225XG0600X | Occupational Therapist - Gerontology | 056004678 | IL |
N | 225XM0800X | Mental Health | 056004678 | IL |
NPI | 1669737995 |
---|---|
Provider Name | Alfreda Williams |
First Address | Chicago, IL 60619-4613 |
Second Address | Chicago, IL 60619-4613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 12/07/2012 |