Individual
AMANDA WANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 E RAWSON AVE STE 317, OAK CREEK, WI 53154-1525
(262) 287-0090
Mailing address
140 E RAWSON AVE STE 317, OAK CREEK, WI 53154-1525
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
056.011910
IL
225X00000X
Occupational Therapist
Primary
6723-26
WI
Other
Enumeration date
09/27/2018
Last updated
12/29/2022
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