Individual
NICOLE RAE TRUNK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
6722 HIGHWAY 50, LAKE GENEVA, WI 53147
(262) 248-2029
Mailing address
6722 HIGHWAY 50, LAKE GENEVA, WI 53147-3647
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
056008541
IL
225X00000X
Occupational Therapist
Primary
5514-26
WI
Other
Enumeration date
03/03/2009
Last updated
09/04/2018
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