Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | IL |
NPI | 1003583378 |
---|---|
Provider Name | Rachel Rose |
First Address | Prairie Grove, IL 60012-2117 |
Second Address | Vernon Hills, IL 60061-1730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2021 |
Last Update Date | 25/08/2021 |