Individual
EMILY A BOURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
814 W 14TH ST, MARSHFIELD, WI 54449-4030
(715) 401-0997
Mailing address
300 E 21ST ST, MARSHFIELD, WI 54449-5023
(715) 401-0997
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4850-27
WI
Other
Enumeration date
11/29/2012
Last updated
11/29/2012
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