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General NPI Number Information
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NPI Number | 1790054070
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Entity Type | Organization
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Legal Business Name | WHOLISTIC OCCUPATIONAL THERAPY LLC
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 6320 W NORTH AVE
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City | WAUWATOSA
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State | WI
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Zip | 53213-2013
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Country | US
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Telephone | 414-258-2981
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Fax | 414-774-0082
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Provider Business Mailing Address
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Address Line | 6320 W NORTH AVE
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City | WAUWATOSA
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State | WI
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Zip | 53213-2013
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Country | US
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Telephone | 414-258-2981
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Fax | 414-774-0082
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. DIANE M. HALLORAN
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Credential | O.T.
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Telephone | 414-258-2981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 992026
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License Number State | WI
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