Individual
RYAN PATRICK BOURDELAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 S 9TH ST, DE PERE, WI 54115-1393
(920) 338-4146
Mailing address
2002 PINK DOGWOOD WAY, SUAMICO, WI 54313-3241
(715) 923-1080
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6155
WI
Other
Enumeration date
12/14/2017
Last updated
12/14/2017
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