Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056004208 | IL |
NPI | 1063720183 |
---|---|
Provider Name | Mrs. Stacy Springer Lenzie |
First Address | Chicago, IL 60613-2830 |
Second Address | Chicago, IL 60613-2830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2010 |
Last Update Date | 23/09/2010 |