Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 056011013 | IL |
NPI | 1407422165 |
---|---|
Provider Name | Ashley Stensland |
First Address | Crystal Lake, IL 60014-7579 |
Second Address | Crystal Lake, IL 60014-7579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2021 |
Last Update Date | 02/06/2021 |