Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057005422 | IL |
NPI | 1003426487 |
---|---|
Provider Name | Allyx Underwood |
First Address | Princeton, IL 61356-1850 |
Second Address | Princeton, IL 61356-1850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2020 |
Last Update Date | 31/07/2020 |