Individual
MIKAYLA ROSE SURPRENANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3615 WASHINGTON RD STE A, KENOSHA, WI 53144-1640
(262) 287-0090
Mailing address
3615 WASHINGTON RD STE A, KENOSHA, WI 53144-1640
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
7107-27
WI
Other
Enumeration date
11/09/2023
Last updated
11/15/2023
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