Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 56014281 | IL |
NPI | 1003585266 |
---|---|
Provider Name | Emily Clysdale |
First Address | Chicago, IL 60661-1375 |
Second Address | Northfield, IL 60093-3046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2021 |
Last Update Date | 10/09/2021 |