Individual
NICHOLAS A GORANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1700 MIDWAY RD, MENASHA, WI 54952-1230
(920) 739-0111
Mailing address
1229 BISMARCK AVE, OSHKOSH, WI 54902-5616
(920) 203-2741
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5256-27
WI
Other
Enumeration date
03/16/2018
Last updated
03/16/2018
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