Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1674-027 | WI |
NPI | 1003926759 |
---|---|
Provider Name | Tonee' Rene Hacker |
First Address | Manitowoc, WI 54220-3712 |
Second Address | Manitowoc, WI 54220-3712 |
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 |
---|---|---|
40887300 | (05) | WI |