Individual
NIKITA FETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
914 N SPRING ST, BEAVER DAM, WI 53916-1752
(920) 382-7202
Mailing address
914 N SPRING ST, BEAVER DAM, WI 53916-1752
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
225X00000X
Occupational Therapist
Primary
8591-26
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/16/2017
Last updated
07/26/2024
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