Provider Demographics
NPI:1306545298
Name:TERRY, EMILY MELISSA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MELISSA
Last Name:TERRY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MELISSA
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53191-9708
Mailing Address - Country:US
Mailing Address - Phone:262-374-1849
Mailing Address - Fax:
Practice Address - Street 1:HWYS. 50 AND 67
Practice Address - Street 2:N2950 STATE RD. 67
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147
Practice Address - Country:US
Practice Address - Phone:262-245-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8204-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist