Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 987-27 | WI |
NPI | 1275815938 |
---|---|
Provider Name | Ellen Katherine Lemay |
First Address | De Pere, WI 54115-1393 |
Second Address | De Pere, WI 54115-1393 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2011 |
Last Update Date | 19/09/2011 |