Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225XM0800X | Mental Health | 056012828 | IL |
NPI | 1467019026 |
---|---|
Provider Name | Hidaia Omer |
First Address | Burr Ridge, IL 60527-0303 |
Second Address | Palos Heights, IL 60463-1139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2019 |
Last Update Date | 29/07/2019 |