Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 4702-027 | WI |
NPI | 1013148881 |
---|---|
Provider Name | Mrs. Crystal Elaine Rogahn |
First Address | Milwaukee, WI 53219-4815 |
Second Address | Milwaukee, WI 53221-4814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 28/07/2009 |