Individual
THERESA DENIEGE LONDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
313 STOUGHTON RD, EDGERTON, WI 53534-1132
(608) 884-0220
Mailing address
313 STOUGHTON RD, EDGERTON, WI 53534-1132
(608) 884-0220
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4911-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801142641
—
WI
Enumeration date
07/30/2012
Last updated
01/16/2013
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