Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 145-026 | WI |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 145-026 | WI |
NPI | 1427215888 |
---|---|
Provider Name | Suellen Brueckner |
First Address | Wauwatosa, WI 53226-4216 |
Second Address | Wauwatosa, WI 53226-4216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 03/06/2008 |