Individual
MRS. VICTORIA ANN CANTRALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1119 N WISCONSIN ST, PORT WASHINGTON, WI 53074-1209
(262) 284-5892
Mailing address
1119 N WISCONSIN ST, PORT WASHINGTON, WI 53074-1209
(262) 284-5892
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1491027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41058700
—
WI
Enumeration date
05/06/2008
Last updated
05/06/2008
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