Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XH1200X | Occupational Therapist - Hand | 056.002782 | IL |
Y | 225XH1200X | Occupational Therapist - Hand | 603-26 | WI |
NPI | 1053729095 |
---|---|
Provider Name | Ruth Chiapetta Kulbacki |
First Address | Mount Pleasant, WI 53406-1828 |
Second Address | Mount Pleasant, WI 53406-1828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2014 |
Last Update Date | 22/07/2014 |