Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 1564 | WI |
NPI | 1063628626 |
---|---|
Provider Name | Michele Mandel |
First Address | Hartford, WI 53027-2245 |
Second Address | Hartford, WI 53027-1608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40708800 | (05) | WI |