Individual
MRS. TRACY WILLMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
8633 32ND AVE, KENOSHA, WI 53142-5187
(262) 694-8800
Mailing address
10102 W 5 MILE RD, FRANKSVILLE, WI 53126-9704
(262) 835-9377
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1233-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40825900
—
WI
Enumeration date
05/07/2007
Last updated
07/08/2007
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