Individual
MS. KELLY REGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1218 79TH ST, KENOSHA, WI 53143-6111
(262) 658-9500
(262) 658-9621
Mailing address
1218 79TH ST, KENOSHA, WI 53143-6111
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
4213-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41037100
—
WI
Enumeration date
04/08/2008
Last updated
04/08/2008
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