Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 056007883 | IL |
NPI | 1548857568 |
---|---|
Provider Name | Mr. Francisco Lasta |
First Address | Chicago, IL 60622-7510 |
Second Address | Chicago, IL 60622-7510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2020 |
Last Update Date | 23/12/2020 |