Individual
KELLY MARIE WIDULE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
2705 ENLOE ST, HUDSON, WI 54016-8173
(715) 690-2600
Mailing address
N8051 925TH ST, RIVER FALLS, WI 54022-4437
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6214-26
WI
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Enumeration date
02/21/2018
Last updated
10/02/2023
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