Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 202035 | MN |
Y | 224Z00000X | Occupational Therapy Assistant | 5127-27 | WI |
NPI | 1023498235 |
---|---|
Provider Name | Crystal Friske |
First Address | Hammond, WI 54015-9615 |
Second Address | Hammond, WI 54015-9615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2015 |
Last Update Date | 02/06/2015 |