Individual
MARCY JEWELL II
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1504 MADISON AVE, FORT ATKINSON, WI 53538-3100
(920) 563-9357
(920) 563-6545
Mailing address
413 HILLCREST DR, FORT ATKINSON, WI 53538-1129
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
90-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36106300
—
WI
Enumeration date
07/17/2006
Last updated
01/22/2014
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