Individual
MR. JAY TIMOTHY BROGELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
N27 W5707 LINCOLN BLVD., CEDAR SPRINGS HEALTH AND REHABILITATION CENTER, CEDARBURG, WI 53012
(262) 376-7676
Mailing address
3468 CLIFFORD DR, HARTFORD, WI 53027-9224
(715) 828-0904
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2047-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41049200
—
WI
Enumeration date
08/20/2007
Last updated
08/20/2007
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