Individual
MRS. KELLY LYN WAALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
111 W MICHIGAN ST, MILWAUKEE, WI 53203-2903
(800) 395-5000
Mailing address
1418 WALSH ACRES DR, WEST BEND, WI 53095-5406
(262) 306-1614
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3172-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40823900
—
WI
Enumeration date
03/24/2007
Last updated
07/09/2007
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