Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 4227026 | WI |
NPI | 1972707305 |
---|---|
Provider Name | Ms. Mari Lynn Carol Young |
First Address | Milwaukee, WI 53221-5255 |
Second Address | Milwaukee, WI 53221-5255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 08/07/2007 |