Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251E1200X | Ergonomics | 1689-026 | WI |
N | 225XE1200X | Ergonomics | 1689-026 | WI |
N | 225XH1200X | Occupational Therapist - Hand | 1689-026 | WI |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1689-026 | WI |
NPI | 1386754927 |
---|---|
Provider Name | Susan Marie Marquardt |
First Address | Manitowoc, WI 54220-3712 |
Second Address | Manitowoc, WI 54220-7316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40816100 | (05) | WI |