Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 7-026 | WI |
NPI | 1508003385 |
---|---|
Provider Name | Ms. Daria Lillian Heyn |
First Address | Milwaukee, WI 53227-2466 |
Second Address | Seymour, WI 54165-1044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2009 |
Last Update Date | 15/01/2009 |