Provider Demographics
NPI:1063480507
Name:WINKELMAN, KELLY KAY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KAY
Last Name:WINKELMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S78W31190 SUGDEN RD
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9395
Mailing Address - Country:US
Mailing Address - Phone:262-363-9820
Mailing Address - Fax:262-363-9955
Practice Address - Street 1:S78W31190 SUGDEN RD
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9395
Practice Address - Country:US
Practice Address - Phone:262-363-9820
Practice Address - Fax:262-363-9955
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2947-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist