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General NPI Number Information
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NPI Number | 1831348879
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Entity Type | Organization
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Legal Business Name | HOME COMFORT LYMPHEDEMA THERAPY LLC
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 6624 LONE OAK DR
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City | SHEBOYGAN
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State | WI
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Zip | 53081-9102
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Country | US
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Telephone | 920-918-7529
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Fax | 920-287-7247
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Provider Business Mailing Address
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Address Line | 6624 LONE OAK DR
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City | SHEBOYGAN
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State | WI
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Zip | 53081-9102
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Country | US
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Telephone | 920-918-7529
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Fax | 920-287-7247
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | LAUREN JUNE MINTEN
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Credential | MOT/OTR-L/CLT
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Telephone | 920-918-7529
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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 | 4552-26
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License Number State | WI
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