Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023782885 |
---|---|
Provider Name | Jonathan Thomas Streckert |
First Address | Wisconsin Rapids, WI 54494-2155 |
Second Address | Wisconsin Rapids, WI 54494-2155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2021 |
Last Update Date | 05/08/2021 |