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General NPI Number Information
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NPI Number | 1619776101
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Entity Type | Individual
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Provider Name | JUSTINE KOPP ATRL-BC
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Gender | Female
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 548 S PARK ST
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-2124
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Country | US
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Telephone | 262-227-6391
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 NIESEN RD
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-1358
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Country | US
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Telephone | 262-227-6391
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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 | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 67-36
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License Number State | WI
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