MEDICARE: EMILY WHITLOCK

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	5475-26	WI

General Provider Information

NPI Number	:	1568877595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY WHITLOCK

Provider Business Mailing Address
First Line	:	2755 N MURRAY AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3646
Country	:	US
Telephone Number	:	262-748-6502
Fax Number	:

Provider Business Practice Location Address
First Line	:	2755 N MURRAY AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3646
Country	:	US
Telephone Number	:	262-748-6502
Fax Number	:

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

Provider Enumeration Date	:	06/28/2014
Last Update Date	:	06/28/2014

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Directions to “ EMILY WHITLOCK ” Practice Location

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