Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057.005238 | IL |
NPI | 1023606423 |
---|---|
Provider Name | Erin Michelle Pickles |
First Address | West Frankfort, IL 62896-1469 |
Second Address | Energy, IL 62933-3568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2021 |
Last Update Date | 02/01/2021 |