Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5771 | WI |
NPI | 1003328469 |
---|---|
Provider Name | Courtney Fedie |
First Address | Rochester, MN 55905-0002 |
Second Address | Eau Claire, WI 54703-5222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2017 |
Last Update Date | 25/01/2022 |