Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XH1200X | Occupational Therapist - Hand | 056012167 | IL |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 056012167 | IL |
NPI | 1003327172 |
---|---|
Provider Name | Katherine Ellen Jones |
First Address | Sycamore, IL 60178-3175 |
Second Address | Sycamore, IL 60178-2703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2017 |
Last Update Date | 17/10/2017 |