Basic Information
| Provider Information | |||||||||
| NPI: | 1922498526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLSKA | ||||||||
| FirstName: | KATHY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15479 CORNELL DR | ||||||||
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| City: | CLINTON TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133842736 | ||||||||
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| Practice Location | |||||||||
| Address1: | 44738 MORLEY DR | ||||||||
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| City: | CLINTON TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480361357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864214062 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2015 | ||||||||
| LastUpdateDate: | 02/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 5502004353 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.