Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | S16506382958 | IL |
NPI | 1003051491 |
---|---|
Provider Name | Brittany Cindy Speron |
First Address | Chicago, IL 60611-2654 |
Second Address | Chicago, IL 60611-2654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2008 |
Last Update Date | 13/12/2008 |