Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056010039 | IL |
NPI | 1043609746 |
---|---|
Provider Name | Jessica L Siegman |
First Address | Evanston, IL 60203-1618 |
Second Address | Evanston, IL 60203-1618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2015 |
Last Update Date | 18/01/2015 |