Provider Demographics
NPI:1295993566
Name:LAGA, JOY R (OTR)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:R
Last Name:LAGA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:R
Other - Last Name:NIENHAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:513 SUSAN ST
Mailing Address - Street 2:
Mailing Address - City:COMBINED LOCKS
Mailing Address - State:WI
Mailing Address - Zip Code:54113-1319
Mailing Address - Country:US
Mailing Address - Phone:920-470-1282
Mailing Address - Fax:
Practice Address - Street 1:1660 HOFFMAN RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6299
Practice Address - Country:US
Practice Address - Phone:920-337-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3154026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40845200Medicaid