Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056010800 | IL |
NPI | 1043739519 |
---|---|
Provider Name | Nicole Nesslar |
First Address | Des Plaines, IL 60016-6574 |
Second Address | Lincolnwood, IL 60712-1820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2017 |
Last Update Date | 15/09/2017 |