Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 267 | WI |
NPI | 1013109917 |
---|---|
Provider Name | Ms. Kristy Gaye Blochwitz |
First Address | Berlin, WI 54923-1551 |
Second Address | Phoenix, AZ 85021-9958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 14/08/2007 |