Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 4585-26 | WI |
Y | 225X00000X | Occupational Therapist | 5201007299 | MI |
NPI | 1003285974 |
---|---|
Provider Name | Mrs. Rhonda L. Shubert |
First Address | Greenfield, WI 53220-2814 |
Second Address | Greenfield, WI 53220-2814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2015 |
Last Update Date | 21/09/2015 |