Individual
KENNA WIECZOREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
801 E SIOUX AVE, PIERRE, SD 57501-3323
(605) 224-3162
Mailing address
108 E 4TH AVE, FORT PIERRE, SD 57532-2341
(605) 280-3918
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1123
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
SD
Enumeration date
11/04/2020
Last updated
11/04/2020
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