Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056009728 | IL |
NPI | 1003223017 |
---|---|
Provider Name | Erin Regan |
First Address | Niles, IL 60714-4577 |
Second Address | Niles, IL 60714-4577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2014 |
Last Update Date | 22/07/2014 |