Organization
BODY & SOUL MFR THERAPY LLC
Active
Parent organization
BODY & SOUL MFR THERAPY LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BODY & SOUL MFR THERAPY LLC
Authorized official
YVONNE VANDER HEIDEN COTA (OWNER)
(920) 209-0012
Entity
Organization
Contact information
Practice address
110 PACKERLAND DR STE C2, GREEN BAY, WI 54303-4861
(920) 209-0012
(920) 888-2409
Mailing address
121 W TOWN RD, PULASKI, WI 54162-9278
(920) 209-0012
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
04/21/2022
Last updated
01/02/2024
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