Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 15188 | FL |
NPI | 1154981868 |
---|---|
Provider Name | Ashley Michelle Burnett |
First Address | Brookfield, WI 53045-2006 |
Second Address | Brookfield, WI 53045-2006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2019 |
Last Update Date | 15/06/2020 |