Individual
MS. MARY MARGARET KEDZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
677 E STATE ST, BURLINGTON, WI 53105-1639
(262) 763-9531
Mailing address
677 E STATE ST, BURLINGTON, WI 53105-1639
(262) 763-9531
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
722-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40733500
—
WI
Enumeration date
06/30/2008
Last updated
06/30/2008
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