Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056006315 | IL |
NPI | 1003323270 |
---|---|
Provider Name | Siobhan T. Cotter |
First Address | Chicago, IL 60655-1702 |
Second Address | Evergreen Park, IL 60805-1401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2018 |
Last Update Date | 17/03/2018 |