| NPI | 1003993809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL L HANDY Billing Manager 920-929-8858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: WI 5225-024) |
| Additional Taxonomies | 225XP0200X Occupational Therapist Pediatrics (Licence: WI 2130) |
| 235Z00000X Speech-Language Pathologist (Licence: WI 1962-154) | |
| 235Z00000X Speech-Language Pathologist (Licence: WI 2236-154) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |