Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056-002357 | IL |
NPI | 1003081134 |
---|---|
Provider Name | Mrs. Kimberly Sue Syregelas |
First Address | Lombard, IL 60148-6130 |
Second Address | Glenview, IL 60026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 29/04/2008 |