Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 056003657 | IL |
NPI | 1346628807 |
---|---|
Provider Name | Mary Jane Sieber |
First Address | Chicago, IL 60657-5640 |
Second Address | Chicago, IL 60657-5640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2015 |
Last Update Date | 15/05/2015 |