Individual
KAREN ANN TICCIONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
13111 N PORT WASHINGTON RD, MEQUON, WI 53097-2416
(262) 243-7444
(262) 243-7486
Mailing address
11811 W BONNIWELL RD, MEQUON, WI 53097-1801
(262) 242-5817
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
944-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40138600
—
WI
Enumeration date
06/15/2006
Last updated
07/09/2007
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