Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1861-027 | WI |
NPI | 1013079029 |
---|---|
Provider Name | Jessica Seymour |
First Address | Galesville, WI 54630-7240 |
Second Address | West Salem, WI 54669-1229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 08/07/2007 |