Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1003442443 |
---|---|
Provider Name | Cassie Blair |
First Address | Seymour, WI 54165-8458 |
Second Address | Menasha, WI 54952-1230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2020 |
Last Update Date | 17/03/2020 |