Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056.014348 | IL |
NPI | 1003581992 |
---|---|
Provider Name | Ms. Natalie Grace Martin |
First Address | Countryside, IL 60525-3699 |
Second Address | Countryside, IL 60525-3699 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2021 |
Last Update Date | 12/08/2021 |