Individual
MRS. KIMBERLY ANN MATSKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
813 SILVER SAGE TRL, MIDDLETON, WI 53562-5684
(608) 469-3794
Mailing address
813 SILVER SAGE TRAIL, MIDDLETON, WI 53562
(608) 469-3794
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
160.005474
IL
174400000X
Specialist
Primary
1902-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160.005474
STATE LICENSE
IL
01
—
1902-19
STATE LICENSE
WI
01
—
TEI000058
STATE LICENSE
PA
Enumeration date
03/21/2007
Last updated
09/13/2012
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