Individual
JILL R LETIZIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
4065 N 35TH ST, MILWAUKEE, WI 53216
(414) 445-9180
(414) 445-5995
Mailing address
2190 HAMMOCK HILL LANE, BROOKFIELD, WI 53045
(262) 782-0712
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
409026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40506300
—
WI
Enumeration date
11/13/2006
Last updated
07/08/2007
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