Individual
KIMBERLY LEIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
307 ROYALL AVE, ELROY, WI 53929-1044
(608) 462-8491
Mailing address
24352 COUNTY HIGHWAY M, WILTON, WI 54670-6012
(608) 797-6721
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5084-27
WI
Other
Enumeration date
01/19/2015
Last updated
01/19/2015
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