Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5104-26 | WI |
NPI | 1952671604 |
---|---|
Provider Name | Rachel Schutz |
First Address | Beloit, WI 53511-2230 |
Second Address | Beloit, WI 53511-2230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2012 |
Last Update Date | 11/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1356413017 | (05) | WI |