Healthcare Provider Details

I. General information

NPI: 1285473389
Provider Name (Legal Business Name): LIVE OAK HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 S HOWELL AVE STE 700
OAK CREEK WI
53154-5000
US

IV. Provider business mailing address

9555 S HOWELL AVE STE 700
OAK CREEK WI
53154-5000
US

V. Phone/Fax

Practice location:
  • Phone: 414-676-2112
  • Fax: 414-676-2122
Mailing address:
  • Phone: 414-676-2112
  • Fax: 414-676-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAUREN LUCIA REHORST
Title or Position: OWNER
Credential: LAC
Phone: 414-975-2730