Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 1583-026 | WI |
NPI | 1285761023 |
---|---|
Provider Name | Theresa Marie Prucha |
First Address | Two Rivers, WI 54241-9733 |
Second Address | Two Rivers, WI 54241-3900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |