Individual
MRS. JEAN LOUISE ADEBOGUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
N27W5707 LINCOLN BLVD, CEDARBURG, WI 53012-2852
(262) 376-7676
Mailing address
10532 N ELDERBERRY LN, MEQUON, WI 53092-4494
(262) 512-0499
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
812-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40723200
—
WI
Enumeration date
05/03/2007
Last updated
07/08/2007
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