Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 002319 | IA |
Y | 225X00000X | Occupational Therapist | 056.010101 | IL |
NPI | 1003235177 |
---|---|
Provider Name | Ms. Sarah Ybarra |
First Address | East Moline, IL 61244-3442 |
Second Address | Silvis, IL 61282-1834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 15/04/2014 |