Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | IL |
NPI | 1013039056 |
---|---|
Provider Name | Julie D Meyers |
First Address | La Grange, IL 60525-3001 |
Second Address | La Grange, IL 60525-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
JM31210399P | ILLINOIS EI PROVIDER (01) | IL |