Individual
NICOLE EIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3415 SHERIDAN RD, KENOSHA, WI 53140-1924
(262) 657-6175
Mailing address
3587 S 75TH ST, MILWAUKEE, WI 53220-1137
(414) 588-2207
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5859-26
WI
Other
Enumeration date
05/13/2016
Last updated
05/13/2016
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