Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057.004385 | IL |
NPI | 1023678844 |
---|---|
Provider Name | Ann Elizabeth Wilson |
First Address | Monticello, IL 61856-8449 |
Second Address | Savoy, IL 61874-8815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2019 |
Last Update Date | 14/06/2019 |