Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 057005572 | IL |
NPI | 1104490374 |
---|---|
Provider Name | Bethany Renae Ruhl |
First Address | Abingdon, IL 61410-1804 |
Second Address | Stronghurst, IL 61480-5052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2021 |
Last Update Date | 13/05/2021 |