Individual
JOSEPH FANTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
11281 N LAKE SHORE DR, MEQUON, WI 53092-3566
(262) 402-8131
Mailing address
11281 N LAKE SHORE DR, MEQUON, WI 53092-3566
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4013-26
WI
Other
Enumeration date
07/02/2024
Last updated
07/02/2024
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