Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5388 | WI |
NPI | 1003241217 |
---|---|
Provider Name | Abbigail Joy Mertig |
First Address | Hudson, WI 54016-8327 |
Second Address | Hudson, WI 54016-8327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2013 |
Last Update Date | 06/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104536 | MINNESOTA LICENSE (01) | MN |
5388 | WISCONSIN LICENSE (01) | WI |