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Individual

MR. JOHN L ELMENDORF III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OTR/L

Contact information

Practice address
1125 N 13TH ST, SHEBOYGAN, WI 53081-3281
(920) 803-1617
(920) 803-1622
Mailing address
1125 N 13TH ST, SHEBOYGAN, WI 53081-3281
(920) 803-1617
(920) 803-1622

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2810-026
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40794400
WI
05
41813000
WI
Enumeration date
11/19/2007
Last updated
10/10/2022
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