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Individual

MRS. KIM MARIE VANDER GALIEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
104 FAKES CT, BEAVER DAM, WI 53916-2699
(920) 219-4941
Mailing address
108 WINDMILL WAY, RANDOLPH, WI 53956-1340
(920) 382-0108

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
793-027
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1699948232
WI
Enumeration date
04/03/2008
Last updated
10/04/2021
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