Individual
EMILY E DESJARLAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2815 NEW PINERY RD, PORTAGE, WI 53901-9257
(608) 742-4131
Mailing address
429 RIDGEWAY DR, RIO, WI 53960-8042
(608) 617-4959
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124083894
EMPLOYER
WI
Enumeration date
06/14/2021
Last updated
06/14/2021
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