Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5563-26 | WI |
NPI | 1164805404 |
---|---|
Provider Name | Rachel Kautz |
First Address | Waukesha, WI 53188-1819 |
Second Address | Milwaukee, WI 53227-3111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2015 |
Last Update Date | 06/07/2015 |