Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XP0200X | Occupational Therapist - Pediatrics | 6436-26 | WI |
NPI | 1043781594 |
---|---|
Provider Name | Sara Andersen |
First Address | Milwaukee, WI 53207-4022 |
Second Address | Mt Pleasant, WI 53177-1616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2018 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043781594 | (05) | WI |