Provider Demographics
NPI:1801232194
Name:LANGTEAU, ELIZABETH JEANNE (OTR)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEANNE
Last Name:LANGTEAU
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 LAKE BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53014-9121
Mailing Address - Country:US
Mailing Address - Phone:920-439-5040
Mailing Address - Fax:
Practice Address - Street 1:569 CARTER CT
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-2201
Practice Address - Country:US
Practice Address - Phone:920-739-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2556-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist