Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5193 | WI |
NPI | 1013385335 |
---|---|
Provider Name | Michelle Brill |
First Address | Richland Center, WI 53581-4013 |
Second Address | Richland Center, WI 53581-4013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2015 |
Last Update Date | 02/09/2015 |