Individual
GAYLE RENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1130 COLLINS RD, JEFFERSON, WI 53549-2939
(920) 674-3170
Mailing address
N6781 SUNSET RD, LAKE MILLS, WI 53551-9767
(920) 723-0253
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
905-027
WI
Other
Enumeration date
12/16/2008
Last updated
12/16/2008
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