Individual
CORTNEY KIM WAKEFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
13 CLIFF RIDGE CT, HUDSON, WI 54016-7736
(507) 219-0504
Mailing address
13 CLIFF RIDGE CT, HUDSON, WI 54016-7736
(507) 219-0504
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104445
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104445
MN LICENSE
MN
01
—
306911
NBCOT CERTIFICATION
—
Enumeration date
04/01/2013
Last updated
04/01/2013
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