Individual
LISA MENDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1130 COLLINS RD, JEFFERSON, WI 53549-2939
(920) 674-6077
Mailing address
N3673 HWY G, FORT ATKINSON, WI 53538
(920) 674-0622
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1506-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40672200
—
WI
Enumeration date
08/15/2006
Last updated
07/08/2007
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