Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057.001203 | IL |
NPI | 1023608189 |
---|---|
Provider Name | Jennifer Becker |
First Address | Sterling, IL 61081-2754 |
Second Address | Sterling, IL 61081-2754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2021 |
Last Update Date | 22/01/2021 |