Provider Demographics
NPI:1013681501
Name:PAVELSEK, EMILY LAUREN (OTR)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LAUREN
Last Name:PAVELSEK
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 1:2655 S 64TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2644
Mailing Address - Country:US
Mailing Address - Phone:813-751-5249
Mailing Address - Fax:
Practice Address - Street 1:1700 W BENDER RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3852
Practice Address - Country:US
Practice Address - Phone:414-351-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7079-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist