Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 490-26 | WI |
N | 225XM0800X | Mental Health | 490-26 | WI |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 490-26 | WI |
NPI | 1235374695 |
---|---|
Provider Name | Mrs. Donna Marie Brocker |
First Address | Milwaukee, WI 53295-0001 |
Second Address | Milwaukee, WI 53295-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2008 |
Last Update Date | 12/12/2008 |