Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 056002417 | IL |
NPI | 1629477179 |
---|---|
Provider Name | Ms. Pamella Lee Leiter |
First Address | Highwood, IL 60040-2049 |
Second Address | Highwood, IL 60040-2049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2014 |
Last Update Date | 21/08/2014 |