Individual
LORI J MIYAZATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
620 W BROWN ST, WAUPUN, WI 53963-1702
(920) 324-6544
Mailing address
620 W BROWN ST, WAUPUN, WI 53963-1702
(920) 324-6544
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3696-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40861500
—
WI
Enumeration date
05/31/2006
Last updated
08/16/2007
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