Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056.011339 | IL |
NPI | 1003336363 |
---|---|
Provider Name | Sarah Weirather |
First Address | Crystal Lake, IL 60012-3335 |
Second Address | Lake Zurich, IL 60047-2450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2017 |
Last Update Date | 27/06/2017 |