Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 580627 | WI |
NPI | 1013689827 |
---|---|
Provider Name | Breeanna Wilkinson |
First Address | West Salem, WI 54669-1308 |
Second Address | West Salem, WI 54669-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2021 |
Last Update Date | 30/09/2021 |