Provider Demographics
NPI:1629233671
Name:HOME COMFORT LYMPHEDEMA THERAPY
Entity Type:Organization
Organization Name:HOME COMFORT LYMPHEDEMA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:MINTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MOT/ OTR/CLT
Authorized Official - Phone:414-534-1570
Mailing Address - Street 1:6624 LONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-9102
Mailing Address - Country:US
Mailing Address - Phone:414-534-1570
Mailing Address - Fax:
Practice Address - Street 1:6624 LONE OAK DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-9102
Practice Address - Country:US
Practice Address - Phone:414-534-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4552-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty