Individual
DR. MINDY A BIRKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD,OTR/L
Contact information
Practice address
21921 DOVE LN, CARLYLE, IL 62231-4717
(618) 971-6979
(618) 749-2041
Mailing address
21921 DOVE LN, CARLYLE, IL 62231-4717
(618) 971-6979
(618) 749-2041
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
056007264
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06032139
BLUE SHIELD PROVIDER NUMB
IL
Enumeration date
09/03/2006
Last updated
09/23/2008
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