Individual
MRS. LYSSA KHAM VANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR
Contact information
Practice address
2895 S MOORLAND RD, NEW BERLIN, WI 53151-3743
(262) 782-0961
(262) 782-9013
Mailing address
2806 S 48TH ST, MILWAUKEE, WI 53219-3301
(414) 329-8462
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4120-026
WI
Other
Enumeration date
12/16/2006
Last updated
07/08/2007
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