Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 6167-26 | WI |
NPI | 1003329467 |
---|---|
Provider Name | Jessica M Lois |
First Address | Westmont, IL 60559-5548 |
Second Address | Salem, WI 53168-8705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2017 |
Last Update Date | 07/12/2018 |