Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056009782 | IL |
NPI | 1043618200 |
---|---|
Provider Name | Shauna Rittenhouse |
First Address | O Fallon, IL 62269-3746 |
Second Address | O Fallon, IL 62269-3746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2014 |
Last Update Date | 19/12/2014 |