Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 904027 | WI |
NPI | 1023282233 |
---|---|
Provider Name | Ms. Joanne Lee Wiegert |
First Address | Ogema, WI 54459-8446 |
Second Address | Ogema, WI 54459-8446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 17/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40890700 | (05) | WI |