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General NPI Number Information
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NPI Number | 1306545298
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Entity Type | Individual
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Provider Name | EMILY MELISSA TERRY OTR/L
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Gender | Female
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | HWYS. 50 AND 67 N2950 STATE RD. 67
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City | LAKE GENEVA
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State | WI
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Zip | 53147
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Country | US
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Telephone | 262-245-0535
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Fax |
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Provider Business Mailing Address
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Address Line | 61 ORCHARD ST
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City | WILLIAMS BAY
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State | WI
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Zip | 53191-9708
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Country | US
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Telephone | 262-374-1849
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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 | 8204-26
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License Number State | WI
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