Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057003544 | IL |
NPI | 1003172669 |
---|---|
Provider Name | Ms. Heather Nicole Marcordes |
First Address | Tinley Park, IL 60477-1649 |
Second Address | Tinley Park, IL 60477-1649 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 09/04/2012 |