Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 056-001248 | IL |
NPI | 1275863656 |
---|---|
Provider Name | Ms. Jane Dietz-Purduski |
First Address | Winfield, IL 60190 |
Second Address | Winfield, IL 60190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2010 |
Last Update Date | 06/01/2010 |