Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4720-26 | WI |
NPI | 1003054115 |
---|---|
Provider Name | Jessica Erin Kurth |
First Address | Weston, WI 54476 |
Second Address | Weston, WI 54476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2009 |
Last Update Date | 06/09/2012 |