Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 496127 | WI |
NPI | 1013351956 |
---|---|
Provider Name | Crystal Leshaye Word |
First Address | Milwaukee, WI 53209-7005 |
Second Address | Milwaukee, WI 53209-7005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 22/04/2013 |