Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 703-026 | WI |
NPI | 1003079096 |
---|---|
Provider Name | Kathleen Stumpf |
First Address | Menasha, WI 54952-1165 |
Second Address | Appleton, WI 54915-1305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 09/07/2008 |