Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | IL |
NPI | 1043430986 |
---|---|
Provider Name | Ms. Shelly Ann Blanski |
First Address | Park Ridge, IL 60068-3929 |
Second Address | Glenview, IL 60025-3070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |