Individual
PAUL S MIKELSON
Active
Individual
PAUL S MIKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
056003882
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056003882
STATE LICENSE
IL
01
—
977378
OT REGISTRATION NUMBER
IL
Enumeration date
05/22/2007
Last updated
11/10/2011
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