Individual
SUSAN LAURA PRIBYL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.O.T.A.
Contact information
Practice address
5000 MEMORIAL DR, TWO RIVERS, WI 54241-3900
(920) 794-5176
(920) 794-5472
Mailing address
E1097 PRIBYL RD, DENMARK, WI 54208-7767
(920) 776-1095
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
502-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40271900
—
WI
Enumeration date
03/08/2007
Last updated
07/09/2007
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