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General NPI Number Information
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NPI Number | 1275207094
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Entity Type | Individual
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Provider Name | LAUREN EDER
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Gender | Female
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 1922 COUNTY ROAD NN
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City | ELKHORN
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State | WI
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Zip | 53121-4454
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Country | US
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Telephone | 262-741-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 13175 W VAN NORMAN AVE
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City | NEW BERLIN
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State | WI
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Zip | 53151-6965
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Country | US
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Telephone |
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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 | 659526
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License Number State | WI
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