Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | IL | |
Y | 225000000X | Orthotic Fitter | IL |
NPI | 1134318603 |
---|---|
Provider Name | Jeff Linton |
First Address | Chicago, IL 60614-3363 |
Second Address | Chicago, IL 60614-3363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2007 |
Last Update Date | 19/10/2007 |