Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5646-26 | WI |
NPI | 1003203399 |
---|---|
Provider Name | Katie Karen Betry |
First Address | Fitchburg, WI 53711 |
Second Address | Fitchburg, WI 53711-6498 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2015 |
Last Update Date | 24/04/2015 |