Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5497-27 | WI |
NPI | 1003305103 |
---|---|
Provider Name | Kassandra Krause |
First Address | Little Chute, WI 54140-1166 |
Second Address | Stevens Point, WI 54482-8974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2018 |
Last Update Date | 03/05/2018 |