Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1361-027 | WI |
NPI | 1003029406 |
---|---|
Provider Name | Mandi Ann Herwig |
First Address | Portage, WI 53901-9149 |
Second Address | Wyocena, WI 53969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |