Individual
BRUCE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COJA
Contact information
Practice address
4065 N 35TH ST, MILWAUKEE, WI 53216
(414) 445-9180
(414) 445-5995
Mailing address
4065 N 35TH ST, MILWAUKEE, WI 53216
(414) 445-9180
(414) 445-5995
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1045027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40757100
—
WI
Enumeration date
08/28/2006
Last updated
07/08/2007
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