Provider Demographics
NPI:1609122399
Name:RIEGLEMAN, LORI A
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:RIEGLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N781 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-9591
Mailing Address - Country:US
Mailing Address - Phone:920-442-4423
Mailing Address - Fax:
Practice Address - Street 1:1280 BROWN ST STE F
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-2489
Practice Address - Country:US
Practice Address - Phone:262-567-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3231146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist