Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2841 | WI |
NPI | 1003072497 |
---|---|
Provider Name | Ms. Joanne Mary Wirtz |
First Address | Green Bay, WI 54311-5537 |
Second Address | Green Bay, WI 54311-5537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2008 |
Last Update Date | 05/08/2008 |