Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5650-26 | WI |
NPI | 1306216676 |
---|---|
Provider Name | Lize Slabbert |
First Address | Oshkosh, WI 54904-7944 |
Second Address | Oshkosh, WI 54904-7944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2015 |
Last Update Date | 30/09/2015 |