Organization
WISCONSIN CENTER FOR MYOFASCIAL RELEASE, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PRISCILLA LINDA HORSWELL (OFFICE MANAGER)
(262) 652-1111
Entity
Organization
Contact information
Practice address
4103 60TH ST, KENOSHA, WI 53144-2509
(262) 652-1111
(262) 652-1124
Mailing address
4103 60TH ST, KENOSHA, WI 53144-2509
(262) 652-1111
(262) 652-1124
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3534-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41012800
—
WI
Enumeration date
04/18/2007
Last updated
08/26/2013
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