Individual
SIVANTHAN PAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
111 W MICHIGAN ST, MILWAUKEE, WI 53203-2903
(360) 123-4567
Mailing address
111 W MICHIGAN ST, MILWAUKEE, WI 53203-2903
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
CA
Other
Enumeration date
04/13/2013
Last updated
01/09/2014
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