Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31006416A | IN |
NPI | 1003390345 |
---|---|
Provider Name | Mr. Milan Marinkovich JR. |
First Address | Crown Point, IN 46307-8150 |
Second Address | Dyer, IN 46311-1167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2018 |
Last Update Date | 22/09/2018 |