Individual
PATRICIA WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Mailing address
1190 E PARADISE DR, WEST BEND, WI 53095-5444
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
836
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23533
INTERNAL ID-MOTOR VEHICLE ID
—
Enumeration date
10/20/2006
Last updated
12/26/2007
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