Individual
DEBORAH ANN WASTART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1226 BERLIN ST, WAUPACA, WI 54981-1991
(715) 942-1422
Mailing address
9084 37TH AVE, FREMONT, WI 54940-9311
(920) 903-2472
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5606-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5606-27
STATE LICENSE
WI
Enumeration date
08/08/2019
Last updated
08/08/2019
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