Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 056.008508 | IL |
NPI | 1720369788 |
---|---|
Provider Name | Mrs. Jodi J Berger |
First Address | Buffalo Grove, IL 60089-1518 |
Second Address | Buffalo Grove, IL 60089-1518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2011 |
Last Update Date | 10/11/2016 |