Individual
MRS. NICHOLE M ELMENDORF
Active
Individual
MRS. NICHOLE M ELMENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
2461
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40806400
—
WI
05
—
41813000
—
WI
Enumeration date
02/10/2008
Last updated
10/10/2022
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