Individual
MR. DESTRY ALLEN FRITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
905 E GENEVA ST, DELAVAN, WI 53115-1922
(262) 728-1442
(262) 728-6693
Mailing address
W9245 STADER RD, WHITEWATER, WI 53190-4157
(262) 472-0348
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1318-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40803900
—
WI
Enumeration date
05/03/2007
Last updated
07/08/2007
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