Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | IL |
NPI | 1003822917 |
---|---|
Provider Name | Ray G Bayer |
First Address | Marion, IL 62959-1439 |
Second Address | Marion, IL 62959-1188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |