Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2909-026 | WI |
NPI | 1134366123 |
---|---|
Provider Name | Mrs. Jill Kathleen Marchan |
First Address | Brookfield, WI 53005-4423 |
Second Address | Brookfield, WI 53005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2009 |
Last Update Date | 13/01/2009 |