Individual
TAMMY R MAGNUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
8348 WASHINGTON AVE, RACINE, WI 53406-3733
(877) 576-3544
Mailing address
8348 WASHINGTON AVE, RACINE, WI 53406-3733
(877) 576-3544
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3332
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40892700
—
WI
Enumeration date
05/23/2007
Last updated
07/08/2007
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