Individual
ANGELA ROSE KJELLBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
425 DAVIS ST, HAMMOND, WI 54015-9615
(715) 796-2218
Mailing address
3775 20TH ST, ELK MOUND, WI 54739-4200
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1269-27
WI
Other
Enumeration date
07/05/2012
Last updated
07/05/2012
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