Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 578-27 | WI |
NPI | 1033322847 |
---|---|
Provider Name | Jane Evenson |
First Address | Helenville, WI 53137-9797 |
Second Address | Jefferson, WI 53549-2939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |