Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4528-26 | WI |
NPI | 1003374315 |
---|---|
Provider Name | Jean Kalscheur |
First Address | Waunakee, WI 53597-1550 |
Second Address | Madison, WI 53703-3546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2019 |
Last Update Date | 05/03/2019 |