Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 6647-26 | WI |
NPI | 1003451972 |
---|---|
Provider Name | Joshua R Luna |
First Address | Sheboygan, WI 53081-5656 |
Second Address | Sheboygan, WI 53081-5656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2019 |
Last Update Date | 14/11/2019 |