Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CX0006X | Orientation and Mobility Training Provider | 2306452 | IL |
NPI | 1124260997 |
---|---|
Provider Name | Kristin Marie Shumann |
First Address | Moline, IL 61265-5932 |
Second Address | Moline, IL 61265-5932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2009 |
Last Update Date | 25/03/2009 |