Individual
TYLER CHRISTIAN MOGENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
325 E FLORIDA AVE, APPLETON, WI 54911-1325
(920) 731-7310
Mailing address
325 E FLORIDA AVE, APPLETON, WI 54911-1325
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5652
WI
Other
Enumeration date
02/01/2022
Last updated
02/01/2022
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