Individual
MEAGAN MARIE DERKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2131 S BUSINESS DR, SHEBOYGAN, WI 53081-5656
(920) 803-1617
(920) 803-1622
Mailing address
2131 S BUSINESS DR, SHEBOYGAN, WI 53081-5656
(920) 803-1617
(920) 803-1622
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4965-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4965-27
LICENSE
WI
Enumeration date
04/02/2014
Last updated
04/02/2014
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