Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1116-026 | WI |
NPI | 1053570507 |
---|---|
Provider Name | Carol Marie Wingenter |
First Address | Brookfield, WI 53005-2970 |
Second Address | Brookfield, WI 53005-2970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 09/06/2008 |