Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056.002935 | IL |
NPI | 1073087094 |
---|---|
Provider Name | Kristin Jean Smith |
First Address | Algonquin, IL 60102-6277 |
Second Address | Algonquin, IL 60102-6277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2019 |
Last Update Date | 12/01/2019 |