Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 211000306 | IL |
NPI | 1164923058 |
---|---|
Provider Name | Larissa Ann Sletto |
First Address | Oakbrook Terrace, IL 60181 |
Second Address | S Barrington, IL 60010-9543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 26/02/2018 |