Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1679724322 |
---|---|
Provider Name | Mrs. Denise Elaine Washington |
First Address | Richton Park, IL 60471-3107 |
Second Address | Richton Park, IL 60471-3107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 30/09/2008 |