Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056-003678 | IL |
NPI | 1003004789 |
---|---|
Provider Name | Robin Poston |
First Address | Bloomington, IL 61704-3738 |
Second Address | Normal, IL 61761-6286 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 13/04/2016 |