Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 139727 | WI |
NPI | 1033291943 |
---|---|
Provider Name | Mrs. Lynn M Caelwaerts |
First Address | Marinette, WI 54143 |
Second Address | Marinette, WI 54143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40859700 | (05) | WI |