Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1003583964 |
---|---|
Provider Name | Megan Elizabeth Cladis |
First Address | Joliet, IL 60436-1480 |
Second Address | Bourbonnais, IL 60914-9584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2021 |
Last Update Date | 26/08/2021 |