Individual
TRICIA KORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
211 S CURTIS ST, LAKE GENEVA, WI 53147-2052
(262) 889-4108
Mailing address
211 S CURTIS ST, LAKE GENEVA, WI 53147-2052
(262) 889-4108
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1602-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861632101
—
WI
Enumeration date
02/26/2009
Last updated
10/29/2012
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