Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 056.001823 | IL |
NPI | 1134440480 |
---|---|
Provider Name | Ms. Deborah Lynn Carlson |
First Address | Park Ridge, IL 60068-1143 |
Second Address | Park Ridge, IL 60068-1143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 21/06/2010 |