Individual
JENNIFER RADKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
210 MARY ST, APT. 103, MAYVILLE, WI 53050-1080
(715) 218-2113
Mailing address
210 MARY ST, APT. 103, MAYVILLE, WI 53050-1080
(715) 218-2113
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4768
WI
Other
Enumeration date
09/09/2010
Last updated
08/06/2013
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