Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056-001297 | IL |
N | 225XP0200X | Occupational Therapist - Pediatrics | 056-001297 | IL |
NPI | 1043753981 |
---|---|
Provider Name | Ms. Lisa Kay Iffland |
First Address | Chicago, IL 60612-4806 |
Second Address | Chicago, IL 60612-4806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2016 |
Last Update Date | 26/11/2016 |