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General NPI Number Information
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NPI Number | 1841963626
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Entity Type | Individual
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Provider Name | JOANNA PODOSEK
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Gender | Female
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 4450 48TH AVENUE CT
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City | ROCK ISLAND
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State | IL
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Zip | 61201-9213
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Country | US
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Telephone | 309-558-0145
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Fax |
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Provider Business Mailing Address
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Address Line | 5720 N MARMORA AVE
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City | CHICAGO
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State | IL
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Zip | 60646-6210
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Country | US
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Telephone | 773-653-4665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056014316
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License Number State | IL
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