Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 056.001346 | IL |
NPI | 1134139488 |
---|---|
Provider Name | Mrs. Lonni R Weis |
First Address | Mattoon, IL 61938-4653 |
Second Address | Effingham, IL 62401-2191 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 22/12/2021 |