Individual
BRENT ALAN NORDQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
425 DAVIS ST, HAMMOND, WI 54015-9615
(715) 688-9174
Mailing address
425 DAVIS ST, HAMMOND, WI 54015-9615
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5620-27
WI
Other
Enumeration date
01/30/2020
Last updated
01/30/2020
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