Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4950-026 | WI |
NPI | 1003119264 |
---|---|
Provider Name | Emily Joann Lucht |
First Address | Mount Calvary, WI 53057-9520 |
Second Address | Sheboygan, WI 53081-7253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2010 |
Last Update Date | 17/01/2012 |