Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 56003701 | IL |
NPI | 1063546257 |
---|---|
Provider Name | Marcia Kilpatrick |
First Address | Chicago, IL 60614-6005 |
Second Address | Chicago, IL 60614-6005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103034 | (05) | IL |