Individual
TANYA JOLMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
450 LAKE DR, MELLEN, WI 54546-9750
(715) 274-5706
Mailing address
63786 SANTAMA RD, ASHLAND, WI 54806-4244
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1802-27
WI
Other
Enumeration date
12/31/2012
Last updated
12/31/2012
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