Individual
MS. PAMELA SUE SPECKBROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
901 MULBERRY ST, LAKE MILLS, WI 53551-1335
(920) 648-8344
Mailing address
5212 MESA RD, MONONA, WI 53716-2915
(608) 221-8275
Taxonomy
Speciality
Code
Description
License number
State
225XR0403X
Driving and Community Mobility Occupational Therapist
Primary
3103026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40853500
—
WI
Enumeration date
05/02/2007
Last updated
07/08/2007
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