Individual
KERRY BETH THORSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
1905 W HART RD, BELOIT, WI 53511-2230
(608) 365-7500
Mailing address
1905 W HART RD, BELOIT, WI 53511-2230
(608) 365-7500
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
5169-26
WI
174400000X
Specialist
Primary
5201007694
MI
Other
Enumeration date
06/07/2011
Last updated
04/30/2014
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