Individual
MRS. JILLIAN ANN STAPLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8633 32ND AVE, KENOSHA, WI 53142-5187
(262) 694-8300
(262) 694-3622
Mailing address
509 NEWMAN RD, RACINE, WI 53406-3448
(262) 770-8355
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
680-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40403800
—
WI
Enumeration date
05/02/2007
Last updated
07/08/2007
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