Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1093297111 |
---|---|
Provider Name | Colleen Sato |
First Address | Chicago, IL 60625-1850 |
Second Address | Chicago, IL 60625-1850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2018 |
Last Update Date | 12/11/2019 |