Healthcare Provider Details

I. General information

NPI: 1336607167
Provider Name (Legal Business Name): EMILY KLIK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 A J ALLEN CIR STE A1
WALES WI
53183-9542
US

IV. Provider business mailing address

543 A J ALLEN CIR STE A1
WALES WI
53183-9542
US

V. Phone/Fax

Practice location:
  • Phone: 262-968-2001
  • Fax: 262-347-3371
Mailing address:
  • Phone: 262-968-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14696-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: