Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5365-26 | WI |
NPI | 1003256652 |
---|---|
Provider Name | Alisha F Mell |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Oconomowoc, WI 53066-4887 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2013 |
Last Update Date | 27/06/2013 |