Individual
CARISSA PONCELET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
706 EAGLE RUN, DELL RAPIDS, SD 57022-2142
(605) 428-5851
Mailing address
4300 E WALKER WAY, SIOUX FALLS, SD 57103-1148
(605) 480-0641
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
000815
IA
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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