Individual
JACOB E LANZENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1970 S RIDGE RD, GREEN BAY, WI 54304-4125
(920) 430-4888
(920) 430-4889
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6589-26
WI
Other
Enumeration date
07/30/2019
Last updated
11/02/2022
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