Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5672-26 | WI |
NPI | 1326433889 |
---|---|
Provider Name | Miss Christina Jacobs |
First Address | Sun Prairie, WI 53590-1840 |
Second Address | Sun Prairie, WI 53590-1840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2015 |
Last Update Date | 01/04/2015 |