Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1502-026 | WI |
NPI | 1083868848 |
---|---|
Provider Name | Mary A. Mcdonnell |
First Address | Milwaukee, WI 53215-4526 |
Second Address | Milwaukee, WI 53215-4526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2008 |
Last Update Date | 06/11/2008 |