Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056.011054 | IL |
NPI | 1023484714 |
---|---|
Provider Name | Ka Yang |
First Address | Milwaukee, WI 53218-5430 |
Second Address | Milwaukee, WI 53218-5430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2015 |
Last Update Date | 17/08/2015 |