Individual
JANE EVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1130 COLLINS RD, JEFFERSON, WI 53549-2939
(920) 674-6077
Mailing address
N4864 N HELENVILLE RD, HELENVILLE, WI 53137-9797
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
578-27
WI
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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