| NPI | 1760729784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA PETRENCHIK Owner 920-376-9335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist Pediatrics (Licence: WI 4976-26) |
| Additional Taxonomies | 225XM0800X Occupational Therapist Mental Health (Licence: WI 4976-26) |
| Enumeration Date | 2013-01-10 |
| Last Update Date | 2013-01-10 |