Individual
MRS. TERESA LYN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
800 NORTH SIXTH STREET, RIVERDALE ELEMENTARY SCHOOL, MUSCODA, WI 53573
(608) 739-3101
Mailing address
800 NORTH SIXTH STREET, RIVERDALE ELEMENTARY SCHOOL, MADISON, WI 53573
(608) 739-3101
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
66-27
WI
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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