Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057000793 | IL |
NPI | 1023546884 |
---|---|
Provider Name | Mrs. Karen Ann Rife |
First Address | Orfordville, WI 53576-8746 |
Second Address | Orfordville, WI 53576-8746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 24/05/2017 |