Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5642-26 | WI |
N | 225XP0200X | Occupational Therapist - Pediatrics | 5642-26 | WI |
NPI | 1023494622 |
---|---|
Provider Name | Choua Linda Vang |
First Address | Wauwatosa, WI 53222-1505 |
Second Address | Glendale, WI 53217-3919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2015 |
Last Update Date | 05/08/2015 |