Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1743-026 | WI |
N | 225XH1200X | Occupational Therapist - Hand | 1743-026 | WI |
NPI | 1053470666 |
---|---|
Provider Name | Becky Jo Scully |
First Address | Madison, WI 53715-1507 |
Second Address | Madison, WI 53715-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 22/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40706500 | (05) | WI |