Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 056003047 | IL |
NPI | 1649695933 |
---|---|
Provider Name | Julie Anne Inda |
First Address | Decatur, IL 62526-3249 |
Second Address | Decatur, IL 62526-3249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2014 |
Last Update Date | 24/02/2014 |