Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 056-006574 | IL |
NPI | 1285611491 |
---|---|
Provider Name | Maile Eddy |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Geneva, IL 60134-2578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 24/02/2016 |