Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5972-26 | WI |
NPI | 1245775667 |
---|---|
Provider Name | Kimberly Noelle Schroeder |
First Address | Wauwatosa, WI 53226-3462 |
Second Address | Wauwatosa, WI 53226-3462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2016 |
Last Update Date | 04/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245775667 | (05) | WI |