Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057.003553 | IL |
NPI | 1013378645 |
---|---|
Provider Name | Holly Witvoet |
First Address | Chicago, IL 60626-4552 |
Second Address | Chicago, IL 60626-4552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2016 |
Last Update Date | 09/03/2016 |