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Organization
WISCONSIN CENTER FOR MYOFASCIAL RELEASE, SC
Active
Organization
WISCONSIN CENTER FOR MYOFASCIAL RELEASE, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PRISCILLA LINDA HORSWELL (OFFICE MANAGER)
(262) 652-1111
Entity
Organization
Contact information
Practice address
4103 60TH ST, KENOSHA, WI 53144-2509
(262) 652-1111
(262) 652-1124
Mailing address
4103 60TH ST, KENOSHA, WI 53144-2509
(262) 652-1111
(262) 652-1124
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3534-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41012800
—
WI
Enumeration date
04/18/2007
Last updated
08/26/2013
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