Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 00444 | IA |
NPI | 1124417779 |
---|---|
Provider Name | Michele Wille |
First Address | Polk City, IA 50226-2129 |
Second Address | Des Moines, IA 50316-2343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2015 |
Last Update Date | 21/01/2015 |