Individual
KIMBERLY ANN STACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
333 W MAIN ST, MADISON, WI 53703-2777
(608) 283-2178
Mailing address
82 S FAIR OAKS AVE # 2, MADISON, WI 53714-2244
(608) 445-8161
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4844-27
WI
Other
Enumeration date
08/25/2011
Last updated
09/10/2011
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