Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1235765314 |
---|---|
Provider Name | Lauren Michelle Henderson |
First Address | Chicago, IL 60611-3167 |
Second Address | Chicago, IL 60611-3167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2020 |
Last Update Date | 20/03/2020 |