Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057002205 | IL |
NPI | 1003064585 |
---|---|
Provider Name | Mr. Ruben Arturo Martinez |
First Address | Chicago, IL 60626-1316 |
Second Address | Chicago, IL 60626-1316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2008 |
Last Update Date | 08/09/2008 |