Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 4715-27 | WI |
NPI | 1003193236 |
---|---|
Provider Name | Ms. Stephanie Keranen |
First Address | Neenah, WI 54956-2867 |
Second Address | Green Bay, WI 54304-5211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2011 |
Last Update Date | 16/11/2011 |