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General NPI Number Information
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NPI Number | 1073734596
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Entity Type | Individual
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Provider Name | LISA R KNOBLAUCH MOTR
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 4545 N 92ND ST
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City | WAUWATOSA
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State | WI
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Zip | 53225-4807
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Country | US
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Telephone | 414-847-3098
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Fax |
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Provider Business Mailing Address
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Address Line | 14340 W FIELDPOINTE DR
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City | NEW BERLIN
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State | WI
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Zip | 53151-1223
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Country | US
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Telephone | 414-217-1017
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4333-026
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License Number State | WI
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