Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053786822 |
---|---|
Provider Name | Angelina Marie Thieme-House |
First Address | West Allis, WI 53227-1031 |
Second Address | West Allis, WI 53227-1031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2015 |
Last Update Date | 04/12/2015 |