Individual
JENNIFER A TABER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 430-4750
Mailing address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 430-4750
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4173
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4173026
LICENSE
WI
Enumeration date
12/07/2005
Last updated
04/28/2014
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