Individual
KELLY HEFTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2448 S 102ND ST, SUITE 340, MILWAUKEE, WI 53227-2466
(414) 329-2500
Mailing address
409 WILSON ST, PLYMOUTH, WI 53073-1053
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4833-27
WI
Other
Enumeration date
09/10/2012
Last updated
09/10/2012
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