Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057.001482 | IL |
NPI | 1003183351 |
---|---|
Provider Name | Mrs. Cassandra Denise Gill |
First Address | Bolingbrook, IL 60440-7849 |
Second Address | La Grange, IL 60525-6130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2011 |
Last Update Date | 30/11/2011 |