Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1114224516 |
---|---|
Provider Name | Alysa Nicole Bainter |
First Address | Pittsfield, IL 62636 |
Second Address | Pittsfield, IL 62363-1441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2011 |
Last Update Date | 04/10/2013 |