Provider Demographics
NPI:1417717166
Name:LANG, ELLEN (MS, OTR)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:LANG RODER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6737 W WASHINGTON ST STE 2250
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-5650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6737 W WASHINGTON ST STE 2250
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-5650
Practice Address - Country:US
Practice Address - Phone:414-416-7306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2398-26225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics