Individual
MRS. KATIE FIONA JERDEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3205 WOOD RD, RACINE, WI 53406-5048
(126) 259-8914
Mailing address
806 MADISON AVE, SOUTH MILWAUKEE, WI 53172-2622
(414) 764-3628
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1921-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40892500
MEDICAID PROGRAM NON BILLING PROVIDER NUMBER
WI
Enumeration date
10/07/2008
Last updated
10/07/2008
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