Individual
MARY P. DIMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
N84W16889 MENOMONEE AVE, MENOMONEE FALLS, WI 53051-2810
(262) 251-7500
(262) 251-7128
Mailing address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4428
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00836840
RR MEDICARE
WI
Enumeration date
08/27/2009
Last updated
09/02/2010
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