Individual
KATIE MARIE KOUBADDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5300 MEMORIAL DR, TWO RIVERS, WI 54241-3923
(920) 686-3609
Mailing address
5300 MEMORIAL DR, TWO RIVERS, WI 54241-3923
(920) 686-3609
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5492
WI
Other
Enumeration date
04/23/2010
Last updated
06/30/2014
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