Organization
WELL & READY KIDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA PETRENCHIK (OWNER)
(920) 376-9335
Entity
Organization
Contact information
Practice address
510 E WISCONSIN AVE STE 4, APPLETON, WI 54911-4865
(920) 376-9335
Mailing address
510 E WISCONSIN AVE STE 4, APPLETON, WI 54911-4865
Taxonomy
Speciality
Code
Description
License number
State
225XM0800X
Mental Health Occupational Therapist
4976-26
WI
225XP0200X
Pediatric Occupational Therapist
Primary
4976-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992082259
—
WI
Enumeration date
01/10/2013
Last updated
01/10/2013
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