Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | IL |
NPI | 1003930694 |
---|---|
Provider Name | Deborah Lynn Solomon |
First Address | Deerfield, IL 60015-2132 |
Second Address | Highland Park, IL 60035-3032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04932193 | BCBS PROVIDER NUMBER (01) | IL |