Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057.001808 | IL |
NPI | 1013254408 |
---|---|
Provider Name | Mrs. Kelli Renee Meents |
First Address | Champaign, IL 61821-3558 |
Second Address | Champaign, IL 61821-3558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2013 |
Last Update Date | 07/01/2013 |