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Individual

MISS CRYSTAL MARIE BORDE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
313 STOUGHTON RD, EDGERTON, WI 53534-1132
(608) 884-1330
Mailing address
313 STOUGHTON RD, EDGERTON, WI 53534-1132

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5466-27
WI

Other

Enumeration date
06/05/2018
Last updated
06/05/2018
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