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Individual

BETHANY LYN ELLWANGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, OTR

Contact information

Practice address
2509 COUNTY HIGHWAY I, HSHS ST JOSEPH'S SPOTS, CHIPPEWA FALLS, WI 54729-2785
(715) 726-3590
(715) 717-7613
Mailing address
2661 COUNTY HIGHWAY I, HSHS ST JOSEPH'S HOSPITAL SPOTS, CHIPPEWA FALLS, WI 54729-5407
(715) 726-3590
(715) 717-7613

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5141
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5141
WISCONSIN LICENSE
WI
Enumeration date
01/25/2012
Last updated
01/05/2022
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