Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | IL |
NPI | 1053486589 |
---|---|
Provider Name | Mrs. Dora Navarro Peters |
First Address | Chicago, IL 60631-1153 |
Second Address | Skokie, IL 60077-1859 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |