Individual
MRS. LISA RENEE HAVERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA/OT
Contact information
Practice address
477 PERCH LAKE RD, HUDSON, WI 54016
(715) 549-6021
Mailing address
477 PERCH LAKE RD, HUDSON, WI 54016
(715) 549-6021
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
3124-26
WI
Other
Enumeration date
06/26/2013
Last updated
06/26/2013
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