Individual
MISS ELIZABETH WIDICUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2195 N SUMMIT VILLAGE WAY, OCONOMOWOC, WI 53066-8675
(262) 560-2426
Mailing address
2238 N 104TH ST, WAUWATOSA, WI 53226-2422
(949) 395-3946
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5327-26
WI
Other
Enumeration date
07/09/2013
Last updated
07/09/2013
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