Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056009727 | IL |
NPI | 1033556956 |
---|---|
Provider Name | Audrey Marie Fields |
First Address | Frankfort, IL 60423-9463 |
Second Address | Frankfort, IL 60423-9463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2013 |
Last Update Date | 01/06/2013 |