Provider Demographics
NPI:1063047439
Name:POPP, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:POPP
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:W8431 BROKEN ARROW RD
Mailing Address - Street 2:
Mailing Address - City:CONRATH
Mailing Address - State:WI
Mailing Address - Zip Code:54731-9800
Mailing Address - Country:US
Mailing Address - Phone:715-312-0705
Mailing Address - Fax:
Practice Address - Street 1:1001 E 11TH ST N
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1455
Practice Address - Country:US
Practice Address - Phone:715-532-5498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5682-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant