Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XM0800X | Mental Health |
NPI | 1568964492 |
---|---|
Provider Name | Jamie Rotter |
First Address | Chicago, IL 60626-2805 |
Second Address | Chicago, IL 60626-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |