Individual
BONNIE DESAUTELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
W330S3331 BRYN MAWR RD, DOUSMAN, WI 53118-9719
(262) 392-2034
Mailing address
W330S3331 BRYN MAWR RD, DOUSMAN, WI 53118-9719
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1266-026
WI
Other
Enumeration date
11/07/2008
Last updated
11/07/2008
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