Provider Demographics
NPI:1083706303
Name:KINSTETTER, LISA H (COTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:KINSTETTER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E 4078 CASCO WEST KEWAUNEE LINE LANE
Mailing Address - Street 2:
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216
Mailing Address - Country:US
Mailing Address - Phone:920-362-3776
Mailing Address - Fax:
Practice Address - Street 1:3311 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5425
Practice Address - Country:US
Practice Address - Phone:920-683-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH108542OtherLICENSE #