Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 4239026 | WI |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | WI |
NPI | 1144433483 |
---|---|
Provider Name | Sherri Vogt |
First Address | Summit, WI 53066 |
Second Address | Summit, WI 53066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 17/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40883200 | (05) | WI |