Provider Demographics
NPI:1316608763
Name:LEHMAN, BREEANNA (MT)
Entity type:Individual
Prefix:
First Name:BREEANNA
Middle Name:
Last Name:LEHMAN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337A JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-1809
Mailing Address - Country:US
Mailing Address - Phone:920-385-1750
Mailing Address - Fax:920-744-1442
Practice Address - Street 1:2337A JACKSON ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-1809
Practice Address - Country:US
Practice Address - Phone:920-385-1750
Practice Address - Fax:920-744-1442
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14726-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist