Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4730-026 | WI |
NPI | 1003041013 |
---|---|
Provider Name | Mrs. Kim Bigari Kavanagh I |
First Address | Sturgeon Bay, WI 54235-1401 |
Second Address | Sturgeon Bay, WI 54235-1284 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2009 |
Last Update Date | 17/02/2015 |