Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 102950 | MN |
NPI | 1003851080 |
---|---|
Provider Name | Jane Marie Flynn |
First Address | Elgin, IL 60123-4756 |
Second Address | Elgin, IL 60123-4756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 13/07/2009 |