MEDICARE: MRS. ELEANOR EUSEBIO SANGALANG OTR/L

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	4329026	WI

General Provider Information

NPI Number	:	1912945320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELEANOR EUSEBIO SANGALANG OTR/L

Provider Business Mailing Address
First Line	:	1550 E ROYALL PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1808
Country	:	US
Telephone Number	:	414-291-1066
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 E ROYALL PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1808
Country	:	US
Telephone Number	:	414-291-1066
Fax Number	:	414-291-1077

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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