Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 056007451 | IL |
Y | 225XG0600X | Occupational Therapist - Gerontology | 056007451 | IL |
N | 225XL0004X | Low Vision | 056007451 | IL |
NPI | 1750680534 |
---|---|
Provider Name | Ms. Melinda Laureen Simonson |
First Address | Lincolnshire, IL 60069-3900 |
Second Address | Vernon Hills, IL 60061-4170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2011 |
Last Update Date | 20/03/2011 |