Individual
KRISTEN LANAE WICHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
200 E TYRANENA PARK RD, LAKE MILLS, WI 53551-9678
(920) 648-8170
Mailing address
N7196 HW Y, WATERTOWN, WI 53094-8502
(920) 699-5512
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3186-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41036200
—
WI
Enumeration date
05/12/2008
Last updated
05/12/2008
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