Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 6936-26 | WI |
NPI | 1013592542 |
---|---|
Provider Name | Nicole Marie Chisholm |
First Address | Hudson, WI 54016-8173 |
Second Address | Hudson, WI 54016-8173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2021 |
Last Update Date | 18/01/2022 |