Individual
JILLENE A BRICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
3305 N BALLARD RD STE C, APPLETON, WI 54911-9001
(920) 735-9234
(920) 739-8288
Mailing address
N3131 REILAND RD, APPLETON, WI 54913-7802
(920) 730-6345
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
356
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40566700
—
WI
Enumeration date
01/25/2007
Last updated
07/09/2007
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