Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31002138A | IN |
NPI | 1003903964 |
---|---|
Provider Name | Judith A Woods |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Munster, IN 46321-3962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 14/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000179164 | BCBS (01) | IN |