Individual
STACY ROGALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
831 PINE BEACH RD, MARINETTE, WI 54143-4225
(715) 732-5796
Mailing address
W4923 COUNTY ROAD G, PORTERFIELD, WI 54159-9410
(715) 789-3171
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1652-26
WI
Other
Enumeration date
08/14/2006
Last updated
07/12/2007
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