Provider Demographics
NPI:1003019035
Name:KAMINSKI, KATY A (MT)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:A
Last Name:KAMINSKI
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 1:500 LAWE ST
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-2022
Mailing Address - Country:US
Mailing Address - Phone:920-766-3741
Mailing Address - Fax:920-766-4217
Practice Address - Street 1:500 LAWE ST
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-2022
Practice Address - Country:US
Practice Address - Phone:920-766-3741
Practice Address - Fax:920-766-4217
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3986-046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist