Individual
MIRANDA L. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
631 HAZEL ST, OSHKOSH, WI 54901-4600
(920) 252-4442
Mailing address
2966 SANDIA DR, GREEN BAY, WI 54313-1423
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
855426
WI
Other
Enumeration date
03/21/2024
Last updated
03/21/2024
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