Individual
MELISSA KULIBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
115 E ARNDT ST, FOND DU LAC, WI 54935-2461
(920) 923-7054
Mailing address
730 WASHINGTON AVE, NORTH FOND DU LAC, WI 54937-1330
(920) 322-0803
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1423-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41038700
—
WI
Enumeration date
05/07/2007
Last updated
07/08/2007
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