Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5115-26 | WI |
N | 225XM0800X | Mental Health | 101773 | MN |
NPI | 1407118607 |
---|---|
Provider Name | Jane Ayre Loll |
First Address | Marshfield, WI 54449-1832 |
Second Address | Marshfield, WI 54449-1832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 13/06/2012 |