Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1104166412 |
---|---|
Provider Name | Eun J Heo |
First Address | Lombard, IL 60148-5367 |
Second Address | Lombard, IL 60148-7029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2013 |
Last Update Date | 22/02/2013 |