Individual
MRS. MARYANN WILLGRUBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
317 KNUTSON DR, MADISON, WI 53704-1133
(608) 301-1968
(608) 301-9388
Mailing address
317 KNUTSON DR, MADISON, WI 53704-1133
(608) 301-1968
(608) 301-9388
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
947-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40884400
—
WI
01
—
947-026
STATE CERTIFICATION
WI
01
—
977355
NBCOT REGISTRATION
WI
Enumeration date
09/22/2006
Last updated
01/21/2021
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