Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | 52167-82 | WI |
Y | 225700000X | Massage Therapist | 3583-146 | WI |
N | 225C00000X | Rehabilitation Counselor | 102923 | WA |
NPI | 1326420225 |
---|---|
Provider Name | Chandra Adams |
First Address | Wauwatosa, WI 53213-2051 |
Second Address | Wauwatosa, WI 53213-2051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2015 |
Last Update Date | 24/08/2015 |