Individual
STACI WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4502 MILWAUKEE ST, MADISON, WI 53714-2133
(608) 249-2137
Mailing address
746 GRACE ST, VERONA, WI 53593-1681
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
947027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40740300
—
WI
Enumeration date
03/27/2007
Last updated
07/08/2007
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