Individual
MR. MICHELLE LEA FULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2530 SHADY LN, BELOIT, WI 53511-7029
(608) 361-9881
Mailing address
2530 SHADY LN, BELOIT, WI 53511-7029
(608) 361-9881
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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