Individual
MS. CAROLYN BETH DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
N27W5707 LINCOLN BLVD, CEDARBURG, WI 53012-2852
(262) 376-7676
(262) 376-5208
Mailing address
N27W5707 LINCOLN BLVD, CEDARBURG, WI 53012-2852
(262) 376-7676
(262) 376-5208
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3714-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLICATIO PENDING
—
WI
Enumeration date
03/18/2009
Last updated
03/18/2009
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