Organization
CERES GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA M PETRENCHIK PH.D,, OTR/L (OWNER AND DIRECTOR)
(920) 740-0128
Entity
Organization
Contact information
Practice address
821 E 1ST AVE, SUITE 3, APPLETON, WI 54911-1500
(920) 257-4601
(920) 257-4603
Mailing address
1518 N HARRIMAN ST, APPLETON, WI 54911-3536
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
497626
WI
Other
Enumeration date
03/30/2012
Last updated
03/30/2012
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