Individual
MRS. KATHERINE LEE EIDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.R.
Contact information
Practice address
3312 TERRACE CT, WAUSAU, WI 54401-4904
(715) 298-2060
Mailing address
3312 TERRACE CT, WAUSAU, WI 54401-4904
(715) 298-2060
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2345-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2345-26
LICENSE NUMBER
WI
05
—
40768800
—
WI
Enumeration date
04/29/2008
Last updated
11/07/2012
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