Provider Demographics
NPI:1194390781
Name:WILLIAMS, KATHRYN CLAIRE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CLAIRE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 N ASTOR ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2164
Mailing Address - Country:US
Mailing Address - Phone:630-544-7520
Mailing Address - Fax:
Practice Address - Street 1:1674 N ASTOR ST APT 2A
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2164
Practice Address - Country:US
Practice Address - Phone:630-544-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI709426225X00000X
MI82307225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist