Individual
SHELLY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
326 S PRAIRIE ST, PRAIRIE DU CHIEN, WI 53821-1723
(608) 433-8493
Mailing address
326 S PRAIRIE ST, PRAIRIE DU CHIEN, WI 53821-1723
(608) 433-8493
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5194-27
WI
Other
Enumeration date
02/25/2016
Last updated
05/28/2019
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