Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 685-026 | WI |
NPI | 1467780601 |
---|---|
Provider Name | Edna Lonergan |
First Address | Milwaukee, WI 53207-3771 |
Second Address | Milwaukee, WI 53207-3771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2009 |
Last Update Date | 17/08/2018 |