Individual
FAUNA K JUSTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1174 NIRA LN, EDGERTON, WI 53534-9433
(192) 034-2964
Mailing address
1174 NIRA LN, EDGERTON, WI 53534-9433
(192) 034-2964
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4415-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1076940
OT LICENSE NATIONAL
WI
01
—
4415-026
STATE LICENSE
WI
Enumeration date
07/24/2007
Last updated
02/22/2017
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