Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1144738519 |
---|---|
Provider Name | Taisha Worlds |
First Address | Lisle, IL 60532-4215 |
Second Address | Lisle, IL 60532-4215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2018 |
Last Update Date | 18/01/2018 |