Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056008865 | IL |
N | 225XH1200X | Occupational Therapist - Hand |
NPI | 1003149725 |
---|---|
Provider Name | Jesse Forest Langille |
First Address | Chicago, IL 60606-1216 |
Second Address | Chicago, IL 60605-2802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2009 |
Last Update Date | 09/04/2014 |