Individual
SAMANTHA NICOLE DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4597
(920) 926-5386
Mailing address
430 E DIVISION ST, FOND DU LAC, WI 54935-4597
(920) 926-5386
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6198
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6198
—
WI
Enumeration date
04/09/2019
Last updated
04/09/2019
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