Individual
LORI A DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
707 S UNIVERSITY AVE, BEAVER DAM, WI 53916-3027
(920) 887-4050
Mailing address
827 SUNSET AVE, WAUPUN, WI 53963-1747
(920) 948-8202
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2067-26
WI
Other
Enumeration date
01/18/2021
Last updated
01/18/2021
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