Individual
AMY BUSALACCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1703 60TH ST, KENOSHA, WI 53140-3986
(262) 658-4125
Mailing address
1703 60TH ST, KENOSHA, WI 53140-3986
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
509226
WI
Other
Enumeration date
11/11/2011
Last updated
11/11/2011
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