Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 160.004069 | IL |
NPI | 1003452095 |
---|---|
Provider Name | Shay N Farris |
First Address | Olney, IL 62450-2553 |
Second Address | Olney, IL 62450-2553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2019 |
Last Update Date | 25/11/2019 |