| NPI | 1720223282 |
|---|---|
| Former Name | KRISTY ELLEN WIENECKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: NY 015492-1) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 015492-1) |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2014-12-23 |