Healthcare Provider Details

I. General information

NPI: 1902265820
Provider Name (Legal Business Name): ELEONOR VAKHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2016
Last Update Date: 02/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 CARIBOU LN
GRAFTON WI
53024-9359
US

IV. Provider business mailing address

2450 CARIBOU LN
GRAFTON WI
53024-9359
US

V. Phone/Fax

Practice location:
  • Phone: 847-707-2992
  • Fax:
Mailing address:
  • Phone: 847-707-2992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5048-27
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: