Individual
DIANE E KILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
N3219 COUNTY ROAD H, LAKE GENEVA, WI 53147-1074
(262) 815-8084
Mailing address
W4735 RIDGEVIEW RD, ELKHORN, WI 53121-2568
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1428-26
WI
Other
Enumeration date
11/22/2017
Last updated
11/22/2017
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