Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | IL |
NPI | 1003096249 |
---|---|
Provider Name | Mrs. Cecile Vitualla Montezon |
First Address | Woodstock, IL 60098-9274 |
Second Address | Woodstock, IL 60098-9274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2007 |
Last Update Date | 05/11/2007 |