Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 3856-026 | WI |
NPI | 1003083858 |
---|---|
Provider Name | Dr. Jill Victoria Fyksen |
First Address | Adams, WI 53910-9722 |
Second Address | Adams, WI 53910-9722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2008 |
Last Update Date | 17/06/2015 |