Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003421660 |
---|---|
Provider Name | Emily Ruff |
First Address | Lexington, IL 61753-1004 |
Second Address | Pontiac, IL 61764-9774 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2020 |
Last Update Date | 10/09/2020 |