Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | ||
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 56009624 | IL |
NPI | 1336604156 |
---|---|
Provider Name | Flora Hassy Kinha-Fandohan |
First Address | Naperville, IL 60564-4997 |
Second Address | Naperville, IL 60564-4997 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2019 |
Last Update Date | 27/02/2019 |