Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056.003397 | IL |
NPI | 1003135203 |
---|---|
Provider Name | Mrs. Michelle T Jones |
First Address | Orland Park, IL 60462-2641 |
Second Address | Orland Park, IL 60462-2641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2010 |
Last Update Date | 27/05/2010 |