Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057004150 | IL |
NPI | 1003277757 |
---|---|
Provider Name | Michael G Todd |
First Address | Kankakee, IL 60901-2959 |
Second Address | Kankakee, IL 60901-2959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2016 |
Last Update Date | 09/03/2016 |