Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056.008795 | IL |
NPI | 1003162009 |
---|---|
Provider Name | Elizabeth A Folliard |
First Address | Oak Lawn, IL 60453-2600 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2012 |
Last Update Date | 27/07/2012 |