Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057.001434 | IL |
NPI | 1003150921 |
---|---|
Provider Name | Barbara Clark-Arzuaga |
First Address | Calumet City, IL 60409-2803 |
Second Address | Calumet City, IL 60409-2803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |