Individual
AGUSTA LILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
910 SUMMER ST, EAU CLAIRE, WI 54701-4240
(715) 379-1268
Mailing address
910 SUMMER ST, EAU CLAIRE, WI 54701-4240
(715) 379-1268
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3653
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017M7LI
BCBS
MN
05
—
41810700
—
WI
01
—
6402271
MEDICA
MN
Enumeration date
09/28/2006
Last updated
04/10/2024
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