Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056.013932 | IL |
NPI | 1043800634 |
---|---|
Provider Name | Kaitlyn Mcgowan |
First Address | Westmont, IL 60559-1291 |
Second Address | Westmont, IL 60559-1291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2021 |
Last Update Date | 20/01/2022 |