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NPI Code Detail

MEDICARE: SOPHIA ELYSE LALLY

MEDICARE: SOPHIA ELYSE LALLY
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
1225XP0200XPediatric Occupational TherapistWI

General Provider Information

NPI Number : 1326993304
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA ELYSE LALLY
Provider Business Mailing Address
First Line : 7670 RED BANK RD
Second Line :
City : SURING
State : WI
Zip : 54174-9520
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3360 GATEWAY RD STE 200
Second Line :
City : BROOKFIELD
State : WI
Zip : 53045-5115
Country : US
Telephone Number : 262-923-7101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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Directions to “ SOPHIA ELYSE LALLY ” Practice Location

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