Individual
MRS. PATRICIA M. VAN DEN KIEBOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
6700 N. PORT WASHINGTON RD., C/O ST. FRANCIS CHILDREN'S CENTER, GLENDALE, WI 53217
(414) 351-8850
(414) 351-8846
Mailing address
6700 N. PORT WASHINGTON RD., C/O ST. FRANCIS CHILDREN'S CENTER, GLENDALE, WI 53217
(414) 351-8850
(414) 351-8846
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3263-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40862700
—
WI
Enumeration date
12/30/2005
Last updated
10/21/2010
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