Individual
LUANN K MATERNOSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
321 BUTTS AVE, TOMAH, WI 54660-1412
(608) 372-2181
(608) 374-0334
Mailing address
321 BUTTS AVE, TOMAH, WI 54660-1412
(608) 372-2181
(608) 374-0334
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3638-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3638-026
WISCONSIN STATE LICENSE
WI
Enumeration date
10/09/2008
Last updated
10/09/2008
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