Individual
MICHELLE L SISLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
702 W DOLF ST, COLBY, WI 54421-9604
(715) 223-2352
Mailing address
N2092 GIBSON DR, MEDFORD, WI 54451-9561
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1038-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40756900
—
WI
Enumeration date
03/26/2007
Last updated
10/11/2012
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