Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | IL |
NPI | 1073635603 |
---|---|
Provider Name | Dr. Christy Lyn Walloch |
First Address | Oak Park, IL 60302-1910 |
Second Address | Chicago, IL 60612-3806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |