Individual
ROBERT LANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOTR
Contact information
Practice address
1401 CHURCHILL ST, WAUPACA, WI 54981-2027
(715) 258-8131
Mailing address
410 E FULTON ST, APT 7, WAUPACA, WI 54981-1256
(414) 313-0705
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5166-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41043600
—
WI
Enumeration date
05/02/2007
Last updated
12/16/2014
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