Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 1268 | WI |
Y | 225XH1200X | Occupational Therapist - Hand | 1268 | WI |
NPI | 1275615007 |
---|---|
Provider Name | Joni Westenberger |
First Address | West Bend, WI 53095-5444 |
Second Address | West Bend, WI 53095-9795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 26/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37156 | INTERNAL ID-MOTOR VEHICLE ID (01) |