Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 056009557 | IL |
N | 225XP0200X | Occupational Therapist - Pediatrics | ||
N | 225XP0200X | Occupational Therapist - Pediatrics | 016038-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 056.009557 | IL |
NPI | 1699087031 |
---|---|
Provider Name | Mrs. Jennifer Lynn Suggitt |
First Address | Willow Springs, IL 60480-1666 |
Second Address | Willow Springs, IL 60480-1666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2010 |
Last Update Date | 05/11/2021 |