Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 056004933 | IL |
Y | 225XH1200X | Occupational Therapist - Hand | 056004933 | IL |
NPI | 1144474321 |
---|---|
Provider Name | Ms. Nicholle Leigh Eisfelder |
First Address | Bloomington, IL 61704-3738 |
Second Address | Bloomington, IL 61704-3738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2008 |
Last Update Date | 21/10/2016 |