Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 056.003247 | IL |
NPI | 1174854707 |
---|---|
Provider Name | Mr. Frank Gerard Czuba |
First Address | Oak Park, IL 60304-1104 |
Second Address | Oak Lawn, IL 60453-2256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2010 |
Last Update Date | 21/01/2010 |