Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO02374 | IL |
NPI | 1053341883 |
---|---|
Provider Name | Jane Candace Rago |
First Address | Springfield, IL 62704-1229 |
Second Address | Springfield, IL 62702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/07/2007 |