Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056003438 | IL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 056003438 | IL |
NPI | 1093228561 |
---|---|
Provider Name | Mary Ellen Stoykov |
First Address | Chicago, IL 60611-3167 |
Second Address | Chicago, IL 60611-2654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2017 |
Last Update Date | 07/11/2017 |