Individual
ANDREA SJAARDEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
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
224Z00000X
Occupational Therapy Assistant
Primary
1891-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41040400
—
WI
Enumeration date
02/05/2007
Last updated
07/08/2007
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