Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 6981-26 | WI |
NPI | 1003480682 |
---|---|
Provider Name | Abigail Carrick |
First Address | Kenosha, WI 53144-2962 |
Second Address | Oak Creek, WI 53154-1525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2021 |
Last Update Date | 18/05/2021 |