Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056.010933 | IL |
NPI | 1003295338 |
---|---|
Provider Name | Miss Andrea Jean Moormann |
First Address | Palos Hills, IL 60465-1393 |
Second Address | Orland Park, IL 60462-4600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2015 |
Last Update Date | 19/05/2015 |