Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056.010749 | IL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 056.010749 | IL |
N | 225XP0200X | Occupational Therapist - Pediatrics | 056.010749 | IL |
NPI | 1821480997 |
---|---|
Provider Name | Kaitlin Floarke |
First Address | Red Bud, IL 62278-1374 |
Second Address | Red Bud, IL 62278-1374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2015 |
Last Update Date | 17/03/2018 |