Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 056.014669 | IL |
NPI | 1548920119 |
---|---|
Provider Name | Mrs. Sadie Belle Siddons |
First Address | Marshall, IL 62441-4698 |
Second Address | Marshall, IL 62441-4698 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2021 |
Last Update Date | 23/12/2021 |