Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 4984-26 | WI |
NPI | 1366735151 |
---|---|
Provider Name | Mrs. Sandra Healy-Johnson |
First Address | New Richmond, WI 54017-1524 |
Second Address | New Richmond, WI 54017-1524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 26/05/2011 |