Individual
KATYA MIRGORODSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 S RAND RD, LAKE ZURICH, IL 60047-2450
(847) 726-1200
Mailing address
141 OAK ST, LAKE ZURICH, IL 60047-1321
(847) 610-0021
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
PENDING
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
PENDING
IL
Enumeration date
02/08/2023
Last updated
02/08/2023
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