Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1799027 | WI |
NPI | 1023278330 |
---|---|
Provider Name | Mrs. Staci White |
First Address | Milwaukee, WI 53210-1650 |
Second Address | Milwaukee, WI 53210-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 10/06/2008 |