Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056007965 | IL |
N | 225XH1200X | Occupational Therapist - Hand | 5201006456 | MI |
NPI | 1184755373 |
---|---|
Provider Name | Mrs. Jessica Kay Barla |
First Address | Oak Brook, IL 60523-8813 |
Second Address | Fishers, IN 46038-1534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 20/04/2017 |