Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 4003026 | WI |
NPI | 1497853899 |
---|---|
Provider Name | Christopher Joseph Suess |
First Address | Manitowoc, WI 54220-3712 |
Second Address | Manitowoc, WI 54220-7316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |