Organization
VALLEY-BAY THERAPY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL J BRICCO (PRESIDENT)
(920) 735-9234
Entity
Organization
Contact information
Practice address
3305 N BALLARD RD STE C, APPLETON, WI 54911-9001
(920) 735-9234
(920) 739-8288
Mailing address
3305 N BALLARD RD STE C, APPLETON, WI 54911-9001
(920) 735-9234
(920) 739-8288
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41213100
—
WI
Enumeration date
01/12/2007
Last updated
12/28/2012
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