Individual
KAYLA MARIE PROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
305 S CLARK ST, MAYVILLE, WI 53050-1488
(920) 387-0354
Mailing address
305 S CLARK ST, MAYVILLE, WI 53050-1488
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5467-27
WI
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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