Healthcare Provider Details

I. General information

NPI: 1770205965
Provider Name (Legal Business Name): NEILANA GOLZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 A J ALLEN CIR STE A1
WALES WI
53183-9509
US

IV. Provider business mailing address

PO BOX 111
DORCHESTER WI
54425-0111
US

V. Phone/Fax

Practice location:
  • Phone: 262-968-2001
  • Fax:
Mailing address:
  • Phone: 715-223-9837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8051-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: