Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1173-26 | WI |
N | 225XG0600X | Occupational Therapist - Gerontology | 1173-26 | WI |
NPI | 1801184809 |
---|---|
Provider Name | Andrea Legatt Carvin |
First Address | Middleton, WI 53562-3839 |
Second Address | Middleton, WI 53562-3839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 06/05/2020 |