Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 056-000699 | IL |
NPI | 1336654938 |
---|---|
Provider Name | Elizabeth Battad Avila-Elayda |
First Address | Chicago, IL 60630-2719 |
Second Address | Skokie, IL 60076-1175 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2017 |
Last Update Date | 06/12/2017 |