Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056013773 | IL |
NPI | 1073118196 |
---|---|
Provider Name | Taylor Quella |
First Address | Chicago, IL 60605-4503 |
Second Address | Wheaton, IL 60189-5855 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2020 |
Last Update Date | 04/12/2020 |