Individual
MRS. KELLY IRENE WATRAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
W6905 PARKVIEW DRIVE, GREENVILLE, WI 54942
(920) 757-9887
Mailing address
7862 COUNTY ROAD H, FREMONT, WI 54940
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13809-146
WI
Other
Enumeration date
09/19/2017
Last updated
06/16/2018
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