Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 403026 | WI |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 403026 | WI |
NPI | 1750474151 |
---|---|
Provider Name | Mrs. Barbara Sue Koehler |
First Address | Madison, WI 53704-1197 |
Second Address | Madison, WI 53704-1133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
403026 | WI STATE OT LICENSE (01) | WI |