Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 2010-026 | WI |
NPI | 1174724074 |
---|---|
Provider Name | Mrs. Alyssa Jacqueline Reas |
First Address | Sun Prairie, WI 53590-1040 |
Second Address | Oregon, WI 53575-1426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 08/07/2007 |