Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056-000744 | IL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 056-000744 | IL |
N | 225XP0200X | Occupational Therapist - Pediatrics | 056-000744 | IL |
NPI | 1861783482 |
---|---|
Provider Name | Mrs. Joyce Ellen Berger |
First Address | Lake Forest, IL 60045-3515 |
Second Address | Lake Forest, IL 60045-1020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2011 |
Last Update Date | 30/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1891028247 | EQUESTRIAN CONNECTION NFP (01) | IL |