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NPI Code Detail

MEDICARE: PAUL GREGORY LANSER OTR

MEDICARE: PAUL GREGORY LANSER OTR
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
1225X00000XOccupational Therapist1755-026WI

General Provider Information

NPI Number : 1811056450
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL GREGORY LANSER OTR
Provider Business Mailing Address
First Line : 7140 PARK SHORES CT
Second Line :
City : MIDDLETON
State : WI
Zip : 53562-3704
Country : US
Telephone Number : 608-836-9847
Fax Number :
Provider Business Practice Location Address
First Line : 245 SYCAMORE ST
Second Line :
City : SAUK CITY
State : WI
Zip : 53583-1013
Country : US
Telephone Number : 608-643-3383
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2006
Last Update Date : 07/08/2007

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