Individual
MARY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1320 WISCONSIN ST, HUDSON, WI 54016-1861
(715) 386-4528
Mailing address
1414 RIDGE RUN, NEW RICHMOND, WI 54017-6946
(715) 417-0770
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
201666
MN
224Z00000X
Occupational Therapy Assistant
Primary
4785-27
WI
Other
Enumeration date
12/21/2014
Last updated
12/21/2014
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