Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056.005664 | IL |
N | 2251E1200X | Ergonomics | 056.005664 | IL |
N | 225XE1200X | Ergonomics | 056.005664 | IL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 056.005664 | IL |
NPI | 1700116225 |
---|---|
Provider Name | Mr. Robert David Joseph |
First Address | Libertyville, IL 60048-2174 |
Second Address | Libertyville, IL 60048-2174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2010 |
Last Update Date | 06/01/2010 |