Individual
MRS. SANDRA DEE BONGARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-5657
Mailing address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-5657
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2099-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123456
—
WI
Enumeration date
04/15/2009
Last updated
04/15/2009
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