Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056012900 | IL |
NPI | 1003373465 |
---|---|
Provider Name | Katelyn Leid |
First Address | Lisle, IL 60532-2040 |
Second Address | Lisle, IL 60532-3711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 19/07/2021 |