Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 056010473 | IL |
NPI | 1659737195 |
---|---|
Provider Name | Nyerere Wert Cobb |
First Address | Chicago Heights, IL 60411-2128 |
Second Address | Chicago Heights, IL 60411-2128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2016 |
Last Update Date | 13/01/2016 |