Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 056011413 | IL |
NPI | 1144805698 |
---|---|
Provider Name | Jamie Anne Avery |
First Address | St Charles, IL 60174-2605 |
Second Address | Geneva, IL 60134-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2021 |
Last Update Date | 16/03/2021 |