Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 40796900 | WI |
NPI | 1033234430 |
---|---|
Provider Name | Mrs. Linda Marie Wetzel |
First Address | Waukesha, WI 53188-4915 |
Second Address | Waukesha, WI 53188-3632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40796900 | (05) | WI |