Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 4708-027 | WI |
NPI | 1033340344 |
---|---|
Provider Name | Heidi Gorman Sunday |
First Address | Washburn, WI 54891-0752 |
Second Address | Ashland, WI 54806-1311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 04/08/2009 |