Individual
MRS. SANDRA LYNN WALDVOGEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5455 DURAND AVE, MOUNT PLEASANT, WI 53406-5008
(262) 598-9146
Mailing address
1128 KILBRIDE DR, RACINE, WI 53402-5604
(262) 752-9520
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
756-27
WI
Other
Enumeration date
01/03/2012
Last updated
01/03/2012
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