Individual
MRS. VICKI LYNN LEISTIKOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
17280 W NORTH AVE, BROOKFIELD, WI 53045-4366
(262) 780-0707
(262) 780-1107
Mailing address
17280 W NORTH AVE, BROOKFIELD, WI 53045-4366
(262) 780-0707
(262) 780-1107
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
305-27
WI
Other
Enumeration date
05/15/2013
Last updated
05/15/2013
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