Individual
KELLY GRISETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 S OAKWOOD RD, OSHKOSH, WI 54904-7944
(920) 223-0424
Mailing address
1570 MIDWAY PL, MENASHA, WI 54952-1165
(920) 720-1464
(920) 720-1728
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4288-026
WI
Other
Enumeration date
10/23/2007
Last updated
10/23/2007
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