Individual
NANCY L KLOCEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
110 BELMONT RD, MADISON, WI 53714-3129
(608) 249-7391
Mailing address
N6035 HARVEY RD, LAKE MILLS, WI 53551-9660
(920) 648-8984
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
197-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197-027
STATE LICENSE
WI
05
—
41035400
—
WI
Enumeration date
05/01/2007
Last updated
07/08/2007
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