Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056.014572 | IL |
NPI | 1023773603 |
---|---|
Provider Name | Debbie Patino |
First Address | Pingree Grove, IL 60140-9197 |
Second Address | Glencoe, IL 60022-1319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2021 |
Last Update Date | 08/11/2021 |