Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033707617 |
---|---|
Provider Name | Alyssa Nicole Lechner |
First Address | Waterloo, IL 62298-1059 |
Second Address | Waterloo, IL 62298-1059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2021 |
Last Update Date | 08/01/2021 |