Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 6870 | WI |
NPI | 1003492794 |
---|---|
Provider Name | Madeline Fritz |
First Address | Sun Prairie, WI 53590-1840 |
Second Address | Sun Prairie, WI 53590-1840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2021 |
Last Update Date | 22/03/2021 |