Individual
MRS. KATHLEEN NORA PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
107 E BECKERT RD, NEW LONDON, WI 54961-2509
(920) 982-5354
(920) 982-9149
Mailing address
107 E BECKERT ROAD, NEW LONDON, WI 54940
(920) 982-5354
(920) 982-9149
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1154-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154-27
STATE LICENSE
WI
Enumeration date
01/31/2013
Last updated
01/31/2013
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