Individual
SARA DAKOTA FULGHUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13203 GLOBE DR STE 111, MOUNT PLEASANT, WI 53177-1616
(262) 287-0090
Mailing address
6058 109TH AVE, KENOSHA, WI 53142-7598
(847) 702-7363
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8155-26
WI
Other
Enumeration date
01/30/2023
Last updated
01/30/2023
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