Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5362-26 | WI |
NPI | 1003254418 |
---|---|
Provider Name | Melissa Brook |
First Address | Sussex, WI 53089-2557 |
Second Address | Milwaukee, WI 53202-1342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2013 |
Last Update Date | 07/06/2013 |