MEDICARE: HOME SAFETY INNOVATIONS L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5309-26	WI

General Provider Information

NPI Number	:	1255740775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME SAFETY INNOVATIONS L.L.C.

Provider Business Mailing Address
First Line	:	500 RUSSELL DR W
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-8845
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 RUSSELL DR W
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-8845
Country	:	US
Telephone Number	:	920-379-4439
Fax Number	:

Authorized Official
Title or Position	:	CO OWNER/ OCCUPATIONAL THERAPIST
Name	:	LEE LOHRENTZ
Credential	:
Telephone Number	:	920-379-4439

Provider Enumeration Date	:	08/08/2014
Last Update Date	:	08/08/2014

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Directions to “HOME SAFETY INNOVATIONS L.L.C. ” Practice Location

Language	Start Address	Practice Location

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