MEDICARE: JILL EHLEN

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	5509-26	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	327832	OTHER	WI	NBCOT CERTIFICATION NUMBER
2	5509-26	OTHER	WI	WISCONSIN STATE LICENSE ID

General Provider Information

NPI Number	:	1508271354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL EHLEN

Provider Business Mailing Address
First Line	:	114 W SHEBOYGAN ST
Second Line	:
City	:	CAMPBELLSPORT
State	:	WI
Zip	:	53010-2853
Country	:	US
Telephone Number	:	920-533-3411
Fax Number	:	920-533-8918

Provider Business Practice Location Address
First Line	:	114 W SHEBOYGAN ST
Second Line	:
City	:	CAMPBELLSPORT
State	:	WI
Zip	:	53010-2853
Country	:	US
Telephone Number	:	920-533-3411
Fax Number	:	920-533-8918

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	01/29/2026

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Directions to “ JILL EHLEN ” Practice Location

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