Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 056008852 | IL |
NPI | 1184015018 |
---|---|
Provider Name | Puja Mukherjee |
First Address | North Riverside, IL 60546-1206 |
Second Address | North Riverside, IL 60546-1206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2015 |
Last Update Date | 13/02/2015 |