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General NPI Number Information
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NPI Number | 1124247598
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Entity Type | Organization
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Legal Business Name | AURORA SHEBOYGAN MEMORIAL MED CENTER
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 2629 N 7TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53083-4932
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Country | US
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Telephone | 920-451-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 238 E BEUTEL RD
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-1106
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Country | US
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Telephone | 262-284-6590
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. MICHELE LEE MUELLER
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Credential | OT
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Telephone | 920-451-5550
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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 | 1823-026
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License Number State | WI
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