Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 3240-026 | WI |
Y | 2251E1200X | Ergonomics | 3240-026 | WI |
Y | 225XE1200X | Ergonomics | 3240-026 | WI |
NPI | 1326260746 |
---|---|
Provider Name | Mrs. Molly Ann Huben |
First Address | Green Bay, WI 54305-2487 |
Second Address | Marinette, WI 54143-3834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 27/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3240-026 | OCCUPATIONAL THERAPIST (01) | WI |
40836400 | (05) | WI |