Individual
KELLY BRIDGETTE SMALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
819 EAST ST, BARABOO, WI 53913-2213
(682) 553-8393
Mailing address
819 EAST ST, BARABOO, WI 53913-2213
(682) 553-8393
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
207218
TX
Other
Enumeration date
02/25/2008
Last updated
02/25/2008
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