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Individual

MRS. JILL MARIE FONK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, OTR/L

Contact information

Practice address
3100 WASHINGTON RD, KENOSHA, WI 53144-1604
(262) 658-4074
Mailing address
3100 WASHINGTON RD, KENOSHA, WI 53144-1604
(262) 658-4074

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3850-026
WI

Other

Enumeration date
04/23/2008
Last updated
04/23/2008
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