Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 056-003684 | IL |
NPI | 1053398230 |
---|---|
Provider Name | Katherine Van Leeuwen |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Geneva, IL 60134-2578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 29/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
753210 | MEDICARE GROUP (01) | IL |
CF2064 | RAILROAD GROUP (01) | IL |