Individual
MR. JEROME ROBERT GRATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3415 SHERIDAN RD, KENOSHA, WI 53140-1924
(262) 657-6175
(262) 657-6681
Mailing address
3415 SHERIDAN RD, KENOSHA, WI 53140-1924
(262) 657-6175
(262) 657-6681
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
406-27
WI
Other
Enumeration date
04/20/2012
Last updated
04/20/2012
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