Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 056.00416 | IL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 056.00416 | IL |
NPI | 1609415587 |
---|---|
Provider Name | Timothy David Nolan |
First Address | Bartlett, IL 60103-4644 |
Second Address | Des Plaines, IL 60016-1209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2019 |
Last Update Date | 24/12/2019 |