Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 234-26 | WI |
N | 225X00000X | Occupational Therapist | 5333 | AZ |
N | 225XH1200X | Occupational Therapist - Hand | 533 | AZ |
NPI | 1023295987 |
---|---|
Provider Name | Kimberly L. Cridelich |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Oconomowoc, WI 53066-4459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2008 |
Last Update Date | 05/01/2017 |