Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | IL |
NPI | 1003935990 |
---|---|
Provider Name | Therese M Seibert |
First Address | Belleville, IL 62223-5007 |
Second Address | Belleville, IL 62223-5007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 08/07/2007 |