Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1702004 | TX |
NPI | 1003019738 |
---|---|
Provider Name | Ronnye Mcinteer |
First Address | Fairview Heights, IL 62208-2034 |
Second Address | Fairview Heights, IL 62208-2034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 08/07/2007 |