Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 248-027 | WI |
NPI | 1013098011 |
---|---|
Provider Name | Gail A Weinand |
First Address | Woodruff, WI 54568-0470 |
Second Address | Woodruff, WI 54568-0470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40577200 | (05) | WI |