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General NPI Number Information
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NPI Number | 1437757986
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Entity Type | Organization
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Legal Business Name | WONDERLAND THERAPY LLC
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 1800 JACKSON ST STE H
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City | LA CROSSE
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State | WI
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Zip | 54601-5800
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Country | US
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Telephone | 608-571-5417
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Fax |
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Provider Business Mailing Address
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Address Line | 2116 WINNEBAGO ST
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City | LA CROSSE
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State | WI
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Zip | 54601-5060
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | LAURA KISH
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Credential | MS, OTR/L
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Telephone | 608-780-1196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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