Individual
ELLEN BLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 GENEVA PKWY N, LAKE GENEVA, WI 53147-4594
(262) 249-3500
Mailing address
700 GENEVA PKWY N, LAKE GENEVA, WI 53147-4594
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6025-26
WI
Other
Enumeration date
04/26/2017
Last updated
04/26/2017
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