Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056014125 | IL |
NPI | 1003496944 |
---|---|
Provider Name | Riya Patel |
First Address | Bloomingdale, IL 60108-8824 |
Second Address | Bloomingdale, IL 60108-8824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 14/04/2021 |