Individual
MICHAEL JON TIERNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTA
Contact information
Practice address
1555 S LAYTON BLVD, MILWAUKEE, WI 53215-1924
(414) 902-2416
Mailing address
8135 S 57TH ST, FRANKLIN, WI 53132-9241
(414) 303-2865
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1562-027
WI
Other
Enumeration date
08/16/2012
Last updated
08/16/2012
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