Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 056.002908 | IL |
NPI | 1700265758 |
---|---|
Provider Name | Vivian Odafe |
First Address | Brookfield, IL 60513-1000 |
Second Address | Brookfield, IL 60513-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2015 |
Last Update Date | 22/05/2015 |