Provider Demographics
NPI:1073123758
Name:REM OCCUPATIONAL HEALTH & WELLNESS INC
Entity Type:Organization
Organization Name:REM OCCUPATIONAL HEALTH & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KELCH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:414-315-3122
Mailing Address - Street 1:W242S10240 MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:BIG BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53103-9750
Mailing Address - Country:US
Mailing Address - Phone:414-315-3122
Mailing Address - Fax:
Practice Address - Street 1:21125 ENTERPRISE AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5229
Practice Address - Country:US
Practice Address - Phone:414-315-3122
Practice Address - Fax:262-753-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1942452289OtherPRIVATE INSURERS