Individual
KIM E JAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
525 AIRPORT DR, ONEIDA, WI 54155-9035
(920) 869-2711
Mailing address
PO BOX 365, ONEIDA, WI 54155-0365
(920) 869-2711
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
265-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40250900
—
WI
Enumeration date
11/07/2006
Last updated
07/08/2007
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