Provider Demographics
NPI:1063643526
Name:KRATZ, SUSAN VAUGHAN (OTR, CST)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:VAUGHAN
Last Name:KRATZ
Suffix:
Gender:F
Credentials:OTR, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W238N1690 ROCKWOOD DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1151
Mailing Address - Country:US
Mailing Address - Phone:262-347-2222
Mailing Address - Fax:262-347-2251
Practice Address - Street 1:W238N1690 ROCKWOOD DR
Practice Address - Street 2:SUITE 500
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1151
Practice Address - Country:US
Practice Address - Phone:262-347-2222
Practice Address - Fax:262-347-2251
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist