Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056-007187 | IL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 056-007187 | IL |
N | 225XP0200X | Occupational Therapist - Pediatrics | 056-007187 | IL |
NPI | 1154741726 |
---|---|
Provider Name | Ms. Beverly A Menninger |
First Address | Aurora, IL 60502-7315 |
Second Address | Crystal Lake, IL 60012-3309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2014 |
Last Update Date | 22/04/2014 |