Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | IL |
NPI | 1063564110 |
---|---|
Provider Name | Elizabeth J Maruyama |
First Address | Downers Grove, IL 60515-4025 |
Second Address | Downers Grove, IL 60515-4025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |