Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057003651 | IL |
NPI | 1023436607 |
---|---|
Provider Name | Renee Klimala |
First Address | Orland Park, IL 60462-2641 |
Second Address | Orland Park, IL 60462-2641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 01/04/2014 |