Individual
MISS TRACI MARGENE STALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
W6112 FAWN CT, MONTELLO, WI 53949-8049
(608) 589-5070
Mailing address
W6112 FAWN CT, MONTELLO, WI 53949-8049
(608) 589-5070
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1129-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1129-27
WI OTA LICENSE NUMBER
WI
Enumeration date
10/23/2007
Last updated
10/23/2007
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