Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 056006499 | IL |
NPI | 1053632653 |
---|---|
Provider Name | Mr. Jan R Delariman |
First Address | Park Ridge, IL 60068-1186 |
Second Address | Park Ridge, IL 60068-1186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2010 |
Last Update Date | 17/06/2010 |