Individual
ELIZABETH FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
611 HARMONY DR, LAKE GENEVA, WI 53147-8800
(262) 249-1960
Mailing address
N7040 PECK STATION RD, ELKHORN, WI 53121-3244
(262) 949-8456
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5336
WI
Other
Enumeration date
03/02/2023
Last updated
03/02/2023
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