Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1592-027 | WI |
NPI | 1003094467 |
---|---|
Provider Name | Heather L Muckler |
First Address | Madison, WI 53717 |
Second Address | Madison, WI 53717-2236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2008 |
Last Update Date | 07/02/2008 |