Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 056.010629 | IL |
NPI | 1164812855 |
---|---|
Provider Name | Mrs. Erica Victoria Johnson-Herrera |
First Address | Chicago, IL 60626-4832 |
Second Address | San Diego, CA 92121-1988 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2015 |
Last Update Date | 02/02/2015 |