Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5603-26 | WI |
NPI | 1003276387 |
---|---|
Provider Name | Stacy Padley |
First Address | Lodi, WI 53555-9503 |
Second Address | Wyocena, WI 53969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2016 |
Last Update Date | 26/08/2016 |