Individual
MRS. KELLY MULDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
138 E PROSPECT ST, PORT WASHINGTON, WI 53074
(262) 689-5265
Mailing address
138 E PROSPECT ST, PORT WASHINGTON, WI 53074
(262) 689-5265
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5045-27
WI
Other
Enumeration date
10/30/2013
Last updated
11/12/2014
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