Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225XH1200X | Occupational Therapist - Hand | 056005236 | IL |
NPI | 1053378570 |
---|---|
Provider Name | Mrs. Zenda Lynn Lewis |
First Address | Effingham, IL 62401-7720 |
Second Address | Effingham, IL 62401-1619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 04/06/2009 |