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Individual

MR. PAUL JOSEPH DERY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
C.O.T.A.

Contact information

Practice address
2512 NEW PINE DR, ALTOONA, WI 54720-1378
(715) 833-0400
(715) 833-0397
Mailing address
2149 15TH ST, EAU CLAIRE, WI 54703-2656
(715) 839-9127

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
871-027
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40880800
WI
Enumeration date
05/16/2007
Last updated
07/08/2007
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