Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5456-27 | WI |
NPI | 1023599347 |
---|---|
Provider Name | Ms. Katarina Djurica |
First Address | Beloit, WI 53511-2230 |
Second Address | Beloit, WI 53511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2018 |
Last Update Date | 24/08/2018 |