Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056.014646 | IL |
NPI | 1003576620 |
---|---|
Provider Name | Miss Asha Rao |
First Address | Mchenry, IL 60050-6411 |
Second Address | Mchenry, IL 60050-6411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2021 |
Last Update Date | 22/12/2021 |