Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 3693-026 | WI |
NPI | 1093269771 |
---|---|
Provider Name | Kara Raisanen |
First Address | Summit, WI 53066-4899 |
Second Address | Summit, WI 53066-4899 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2016 |
Last Update Date | 10/08/2016 |