Individual
ERIC B JERDEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4308 WHITE OAK LN, SHEBOYGAN, WI 53083-2178
(920) 889-9290
Mailing address
4308 WHITE OAK LN, SHEBOYGAN, WI 53083-2178
(920) 457-4566
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2455-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40791500
—
WI
Enumeration date
06/09/2007
Last updated
07/15/2024
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