Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 056-002019 | IL |
Y | 225X00000X | Occupational Therapist | 056002019 | IL |
NPI | 1952380479 |
---|---|
Provider Name | Diane Marie Baylor |
First Address | Oak Brook, IL 60523-1925 |
Second Address | Elgin, IL 60120-5160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 23/07/2021 |