Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5708 - 26 | WI |
NPI | 1073997193 |
---|---|
Provider Name | Payal Patel |
First Address | Racine, WI 53403 |
Second Address | Mount Pleasant, WI 53403-3995 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2015 |
Last Update Date | 18/07/2015 |