Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 319239 | WI |
NPI | 1063811966 |
---|---|
Provider Name | Dana Sosinski |
First Address | Mukwonago, WI 53149-9016 |
Second Address | Mukwonago, WI 53149-9016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2014 |
Last Update Date | 15/08/2014 |