Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5094-26 | WI |
NPI | 1265702849 |
---|---|
Provider Name | Suzanne Salvato |
First Address | Kenosha, WI 53144-1957 |
Second Address | Salem, WI 53168-8705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2012 |
Last Update Date | 14/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
860400015 | MEDICARE (01) | WI |