Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056012446 | IL |
NPI | 1013410406 |
---|---|
Provider Name | Reagan Lockwood |
First Address | Chicago, IL 60618-6796 |
Second Address | Chicago, IL 60618-6796 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2018 |
Last Update Date | 13/03/2018 |