Individual
BETH ANNE ELISZEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1922 CTH-NN, ELKHORN, WI 53121
(262) 741-3600
Mailing address
S88W25970 EDGEWOOD AVE, MUKWONAGO, WI 53149-8542
(414) 614-4146
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
965
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40735900
—
WI
Enumeration date
05/08/2007
Last updated
02/12/2021
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