Provider Demographics
NPI:1225150220
Name:KILDAHL, DEBRA DAWN (OTR)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:DAWN
Last Name:KILDAHL
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 1:408 AMPARO ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-1445
Mailing Address - Country:US
Mailing Address - Phone:414-313-5710
Mailing Address - Fax:
Practice Address - Street 1:146 CLOVER ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-9779
Practice Address - Country:US
Practice Address - Phone:262-245-9574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4259-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist