Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056010563 | IL |
NPI | 1003359969 |
---|---|
Provider Name | Kathleen Needham |
First Address | Oak Lawn, IL 60453-5221 |
Second Address | Chicago, IL 60614-2730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2016 |
Last Update Date | 19/10/2018 |