Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1166 | WI |
N | 2251E1200X | Ergonomics | 1166 | WI |
N | 225XE1200X | Ergonomics | 1166 | WI |
N | 225XH1200X | Occupational Therapist - Hand | 1166 | WI |
NPI | 1285823161 |
---|---|
Provider Name | Ann V. John |
First Address | Cedarburg, WI 53012-9188 |
Second Address | Cedarburg, WI 53012-9188 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2007 |
Last Update Date | 17/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
391550272010 | BCBS GROUP BILLING NUMBER (01) | WI |
40643000 | (05) | WI |
41213500 | MEDICAID GROUP # (01) | WI |