Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057.003305 | IL |
NPI | 1013384957 |
---|---|
Provider Name | Marta Michalczyk |
First Address | Chicago, IL 60707-1153 |
Second Address | Chicago, IL 60707-1153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2015 |
Last Update Date | 26/08/2015 |