Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5935 | WI |
NPI | 1003365958 |
---|---|
Provider Name | Miss Kathryn Pittz |
First Address | Willard, WI 54493-8900 |
Second Address | Neillsville, WI 54456-1706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2016 |
Last Update Date | 03/10/2016 |