Individual
MARIAH L RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2575 7TH ST S, LA CROSSE, WI 54601-5249
(608) 406-3951
Mailing address
2575 7TH ST S, LA CROSSE, WI 54601-5249
(608) 406-3951
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5496-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5496-27
—
WI
Enumeration date
03/15/2019
Last updated
03/15/2019
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