Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 4071-026 | WI |
NPI | 1306889845 |
---|---|
Provider Name | John Heinle |
First Address | Milwaukee, WI 53211-2906 |
Second Address | Milwaukee, WI 53211-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |