Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 056011394 | IL |
NPI | 1205392347 |
---|---|
Provider Name | Lily Elise Hult |
First Address | Chicago, IL 60654-6703 |
Second Address | Chicago, IL 60612-1737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2019 |
Last Update Date | 13/02/2019 |