Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1970-19 | WI |
NPI | 1205279817 |
---|---|
Provider Name | Megan Oeth |
First Address | Madison, WI 53716-2837 |
Second Address | Madison, WI 53716-2837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2013 |
Last Update Date | 12/04/2013 |