MEDICARE: NANCY JOY STILLMAN O.T.R.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1218-026	WI

General Provider Information

NPI Number	:	1013956481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY JOY STILLMAN O.T.R.

Provider Business Mailing Address
First Line	:	1825 E LAKE BLUFF BLVD
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-1605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2449 E BRADFORD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4174
Country	:	US
Telephone Number	:	414-963-8476
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/08/2007

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