Healthcare Provider Details

I. General information

NPI: 1275953853
Provider Name (Legal Business Name): NATALIE J. ZELLMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17280 W NORTH AVENUE
BROOKFIELD WI
53045
US

IV. Provider business mailing address

37428 INDIAN MOUND RD
OCONOMOWOC WI
53066
US

V. Phone/Fax

Practice location:
  • Phone: 262-780-0717
  • Fax:
Mailing address:
  • Phone: 262-569-0941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number56826
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: