| NPI | 1538858857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENIFER TILLMANN Credentialing/Contracting Sp 920-560-1147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2023-05-03 |