Individual
MRS. KELLY LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3601 S CHICAGO AVE, SOUTH MILWAUKEE, WI 53172-3708
(414) 764-4100
(414) 764-0706
Mailing address
3601 S CHICAGO AVE, SOUTH MILWAUKEE, WI 53172-3708
(414) 764-4100
(414) 764-0706
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
5330
WI
225X00000X
Occupational Therapist
Primary
5330
WI
Other
Enumeration date
05/02/2017
Last updated
10/23/2019
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