Individual
MARY KIRCHBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
4200 SAVANNAH DR, DE FOREST, WI 53532-2909
(608) 417-3370
Mailing address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-6000
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3927-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187653485
—
WI
Enumeration date
12/12/2006
Last updated
01/15/2015
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